Charles Gaba's blog


Regular readers know that I spent countless hours last summer tracking down the requested average 2016 rate change filing forms for every single state in the country, and then compiling them into my best guesstimate about the overall, weighted average rate changes for the individual policy market in each state and nationally.

In the end, I came up with a national projected weighted average increase of 12-13%, although I also made sure to note that I expected the effective average to only be around 9% after the dust settled...due to people shopping around.

As it happens, I turned out to be pretty much dead on target: The "presumptive" average (ie, assuming every single enrollee stayed with the same policy whenever possible) ended up being 11.6% nationally, while the effective average ended up being 8%.

With only 584,000 residents, Wyoming is the smallest state, with a population over 10% smaller than even the District of Columbia or Vermont. Last year there were only 2 insurance carriers offering individual policies on the ACA exchange, Blue Cross and WINhealth. The average rate increase for 2016 was right around 10% even.

Unfortunately, WINhealth, a not-for-profit organization which had been around for 20 years, ended up as one of the few NON-Co-ops to go belly up last fall due specifically to Marco Rubio's Risk Corridor Massacre:

WINhealth sent along this release saying: As of October 8, 2015, WINhealth has chosen not to participate in the individual market, to include the federal exchange, for the 2016 plan year. The decision not to participate stems from a recent announcement from the federal government regarding the risk corridor program .

Hoo, boy. Here comes the pain.

Last year, the Texas ACA-compliant individual market carriers requested an average rate hike of around 16%, although it was a pretty fuzzy guesstimate since I couldn't track down the average rate hikes for about 25% of the market other than knowing that whatever it was, it was under 10%.

This year, the good news is that CMS has started posting all rate change requests whether over or under 10%, making it easier to fill in some of the data. The bad news is that 3 of the 19 carriers offering individual policies next year redacted any data giving a clue as to what their current enrollment numbers are: CHRISTUS, Community First and Oscar Insurance.

The other 16 carriers did provide those numbers pretty clearly (except for Sendero, which only gave a projection of "member months" which I had to divide by 12 to get a rough enrollment estimate).

(sigh) Once upon a time, there were 24 ACA-created Co-Ops. Then, after one of them failed to even make it through the 2nd open enrollment period, a variety of factors (culminating in the infamous Risk Corridor Massacre) caused another dozen or so to curl up & die, falling like dominoes throughout last September/October.

When the dust settled, there were 11 Co-Ops left standing, but most of them were still on pretty shaky ground, with all but a handful placed under "enhanced oversight" by their states (and I have to admit that the term sounds an awful lot like a euphamism, a la "enhanced interrogation technique").

Last year, the insurance carriers in Pennsylvania asked for a weighted average 15.6% rate increase for individual market policies...but in the end state regulators knocked these down by over 1/5th to around 12% overall.

This year the picture is uglier, as expected. While four of the filings are for rate hikes of under 10%, this is misleading because one of them appears to be brand new while the other 3 have a combined enrollment of...7 people. Not 7,000, not

The rest of the filings range from 16% to a whopping 48% increase request from Highmark Health Insurance for over 20,000 enrollees. Ouch.

Overall, the weighted state-wide average requested rate hike on the individual exchange is 23.6%.

Thanks to Kevin Wright (via Twitter) for calling the latest bit of idiocy from the Donald Trump campaign to my attention:

What Would Happen if Donald Trump’s Healthcare Plan Was Implemented?

Imagine this scenario next year.

In January, President Donald J. Trump asks Congress on his first day in office to repeal Obamacare.

The House and Senate oblige and eight months later on Oct. 1 the Affordable Care Act (ACA) goes out of business.

In its place, the seven-point healthcare plan listed on the Trump campaign website is implemented.

...“It will make the healthcare industry more affordable and more accessible,” Sam Clovis, the national co-chairman and a policy advisor for the Trump campaign, told Healthline.

However, five experts interviewed by Healthline don’t see quite as rosy a picture.

...“Not everybody needs to have health insurance,” said Clovis. “Healthy people having to pay the insurance costs of unhealthy people is a nonstarter.”

Jill Filipovic is an American journalist living abroad. She's from New York, but has been living overseas for some time, reporting for the Guardian and a whole mess of other respected publications.

About an hour ago, she tweeted the following:

My insurance company @Cigna confirms it won't cover contraception, abortion, or, for the 1st year, pregnancy. What are women supposed to do?

— Jill Filipovic (@JillFilipovic) May 25, 2016

A bunch of people immediately expressed confusion since, as HHS spokesman Aaron Albright pointed out, under the ACA...

Every health insurance plan sold in the Marketplace will offer 10 essential health benefits.

What’s covered in the Health Insurance Marketplace

These essential health benefits include at least the following items and services:

The good news about estimating the DC exchange rate hike requests is that the DC Dept. of Insurance, Securities & Banking is pretty transparent about posting this info, and they keep it simple. It's simpler still because like Vermont, DC requires that all individual and small group policies be sold on the exchange, so there's no off-exchange data to track down.

The bad news is that it's a little bit too simple: Only two carriers (CareFrist and Kaiser) offer policies via the individual exchange, and only CareFirst is offering PPOs:

Having said that, I'm not sure what to make of this part of the official press release:

Last June, when the CMS division of the HHS Dept. launched their new Rate Review searchable database, I was simultaneously extremely satisfied and utterly frustrated with it.

As I noted a year ago: terms of following the requirements of the HHS Dept, it's very useful for people to look up their particular company in their state, see what their "average" rate increase request is and submit cranky public comments (which will in most cases probably be ignored, but hey, you never know).

And yes, this certainly makes it easier to fill in some of the missing pieces of the puzzle, and helps cut down on how much hunting around people like myself have to do to track down some of this data. For that alone, I'm extremely glad to see this tool added.

Last year, Indiana was one of only two states to see virtually flat year over year premium increases on the ACA-compliant individual market, with rates going up a mere 0.7% on average. This year, unfortunately, that won't be the case...although at least one carrier, Celtic, is reducing their average rates by over 5%.

The good news is that I was able to track down the average rate change for all 6 carriers offering individual plans in Indiana (UnitedHealthcare is dropping out of the market, and I'm not sure what's going on with Aetna and Coordinated Care Corporation, both of which do have listings in Indiana's SERFF database for 2017...but neither of which has any actual filings listed. I presume these are placeholders for them to potentially enter the state market, which would be a good thing (and which Aetna has already indicated they might be doing next year). In addition, Golden Rule says that they'll be offering ACA-compliant policies starting next year as well (mainly for their current "transitional" enrollees).

The bad news is that while I've hunted down the current enrollment numbers for 5 of the 6 renewing carriers, one of them, MDwise, is frustratingly unknown, making it tricky to calculate a weighted average rate hike. Actually, I only have hard numbers for 4 carriers; for Celtic I had to cheat a bit by using their projected enrollment for next year. At 197,000 member months, that's an average of around 16,400 enrollees both on & off the exchange.

Without MDwise included, the average of the other 5 carriers comes in at 19.25%. However, MDwise is only (only is relative, I realize) requesting an 11.5% average hike, so any additional enrollees from them would bring that average down somewhat. The problem is figuring out how many current enrollees MDwise has:

Amidst all the hand-wringing over how much healthcare premium rates are expected to go up next year, there's one factor which I haven't really mentioned before. I've probably made a passing reference to it here and there, but I don't think I've focused on it prior to this entry.

Old people, generally speaking, require more medical care than young people. This isn't an absolute, of course; there are 60-year olds who can kick a 30-year old's ass, and while younger people tend to be healthier than the elderly, they also tend towards more risky behavior, be it reckless driving, bungie jumping or whatever. Still, the fact remains that there's a reason why insurance carriers lust after so-called "Young Invincibles" so much: They tend to be relatively low-risk and inexpensive to treat when something does come up.

The conventional wisdom when it comes to taxes is that Republicans are always for cutting 'em while Democrats are always for raising 'em. The reality, of course, can be far more complicated--it's not just about cutting or raising taxes, it's also about who's getting the increase/decrease and what the money would/no longer would be used for. Even so, this is an odd-sounding story at first glance.

Just last week, the Big News Shocker out of Oklahoma was the blood-red Republican-controlled state legislature and governor were actually considering a) raising taxes (!!!) and b) expanding Medicaid via the ACA (!!!) in order to dig themselves out of their self-dug financial hole:

So, in what would be the grandest about-face among rightward leaning states, Oklahoma is now moving toward a plan to expand its Medicaid program to bring in billions of federal dollars from Obama's new health care system.

What's more, GOP leaders are considering a tax hike to cover the state's share of the costs.

This year only 3 insurance carriers are offering policies on the individual market in Rhode Island: Blue Cross Blue Shield, Neighborhood Health Plan and UnitedHealthcare. The bad news is that United is pulling out of RI, although they only hold about 4% of the on-exchange market anyway. The rest of the on-exchange market is split almost evenly between BCBS and Neighborhood.

Both Neighborhood Health Plan and BCBS have submitted their filings, and there's some great (and surprising, for this year) news:

Carriers file two average rate increase amounts with OHIC: the EHB base rate increase and the weighted average rate increase. These two percentages reflect different calculations.

It's true: High deductibles and co-pays are a serious and growing problem for many people. HOWEVER, the most depressing finding of this morning's survey results by the Kaiser Family Foundation was this one:

The survey also finds a lack of awareness about new rules for coverage introduced by the ACA. Among all those with ACA-compliant coverage, fewer than half (47 percent) know that preventive services are covered completely by their plans, while a third (33 percent) think that copays or deductibles apply to preventive services and one in five (20 percent) are not sure. Among those in high-deductible plans, awareness is even lower: 41 know that preventive services are covered with no cost-sharing.

Therefore, I now present a list of services which are covered at no cost whatsoever to anyone enrolled in an ACA exchange health insurance policy:

The Kaiser Family Foundation has just released their 3rd Annual survey of people enrolled in the "Non-Group Health Insurance Market", otherwise known as the Individual market. It's important to note that this survey includes Americans enrolled in all individual market plans, both on and off-exchange. There are technically 5 separate categories, although they can effectively be merged into three categories for most purposes:

  • 1. EXCHANGE-based QHPs (Qualified Health Plans)
  • 2a. OFF-Exchange QHPs
  • 2b. OFF-Exchange ACA-compliant non-QHPs
  • 3a. OFF-Exchange NON-ACA compliant "Grandfathered" plans (ie, enrolled in prior to 2010)
  • 3b. OFF-Exchange NON-ACA compliant "Transitional" or "Grandmothered" plans (ie, enrolled in between 2010 and 2013)

I tend to merge #2 & 3 together (off-exchange, ACA-compliant) in virtually all cases, and merge #4 & 5 together (grandfathered/grandmothered) except in cases where I need to make a distinction.

First, KFF's methodology: