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%.

Regular readers know that I used to regularly post an entry about the official CMS Medicaid enrollment reports every month, documenting the increase in Medicaid enrollment since ACA expansion went into effect. The numbers were increasing dramatically every month for nearly two years, but started slowing down last fall as most of the expansion states started maxing out on their eligible enrollees.

In fact, I realized this morning that I got so caught up in other ACA stories earlier this year that I haven't even posted a monthly update once since last November!

As of November 2015, there had been a net increase of 14.1 million people added to the Medicaid rolls since October 2013 (the month when ACA expansion enrollment began), plus another 950,000 people who had already been quietly transferred over to Medicaid from existing, state-funded programs prior to 2013 via other ACA provisions.

OK, this is about xenophobia, bigotry, antisemitism and stupidity, not healthcare...but I couldn't resist:

The woman who wants to be the next President of the United States is not wearing an American flag lapel pin tonight. #DemsInPhilly

— Katie Pavlich (@KatiePavlich) July 29, 2016

@KatiePavlich no but Bill has one in arabic from last night...

— Michael Lowerre (@bigmikeinfla) July 29, 2016

@bigmikeinfla @KatiePavlich That's Hebrew

— Dan Mangan (@_DanMangan) July 29, 2016


There's been numerous mentions this week at the Democratic National Convention about Hillary Clinton's role in creating the Children's Health Insurance Program (CHIP), and with good reason.

The number which keeps getting thrown around is "over 8 million" (which is true), while the official CHIP website lists it as 8.1 million (which was true for 2014).

However, out of curiousity, I took a look to see what the 2015 data is, and sure enough, it was up to 8.4 million last year.

Here's a table showing, state by state, how many children were enrolled in the CHIP program last year (as well as the number in Medicaid, which, surprisingly, is actually more than 4x higher). In fact, well over half of all Medicaid enrollees are children.

NOTE: "Ever Enrolled" is confusing; it makes it sound like this is cumulative since the 1990's. It actually means "ever enrolled during that year", since there's a lot of churn with children moving into or out of the program as their family situation changes over time:

(Note: I've had to re-work some of this entry thanks to clarifications from Adam Cancryn about the RBC rule; too many little edits to document each one).

Last week I posted about the latest ugly Co-Op meltdown, this time Land of Lincoln Health (LoL) of Illinois.

As pointed out in my follow-up entry, given the precarious financial state LoL was already in last year, it made little sense that they only asked for fairly nominal rate hikes:

Now, since LoL went belly-up mid-year regardless, obviously even those massive rate hikes weren't enough to save them, so the question is, what would have happened if LoL had gotten their nominal increases as requested?

The most recent ACA/healthcare news out of Illinois was the ugly announcement that Land of Lincoln Health is the latest ACA-created Co-Op to go belly-up, leaving 49,000 people (39,000 on individual plans and 10,000 in the small group market) having to scramble to find new coverage in the middle of the year. This was on top of recent news that UnitedHealthcare is pulling out of dozens of states including Illinois (Humana is also dropping out of a bunch of states, but I don't think Illinois is among them).

Well, nature (and the market) abhors a vacuum, so guess what?

One of the nation's largest health insurance companies plans to enter the Obamacare marketplace in the Chicago area for the first time, bringing new competition as other insurers exit or go out of business.

My posts have been pretty light of late; between being on vacation, a big work backlog when I got back, and getting wrapped up in the RNC and DNC craziness, I've been a bit off-track. I'm hoping to catch up a bit over the next week or so.

Case in point: Last week, the Minnesota exchange, MNsure, posted their latest monthly enrollment numbers. Normally they include a full slideshow dashboard report, but I can't find it for July. The basic numbers through July 20, however, are:

  • Medical Assistance: 244,736
  • MinnesotaCare: 72,972
  • Qualified Health Plan (including SHOP): 96,923
  • TOTAL: 414,631

As of 6/12, MNsure had 95,637 QHP selections, so this is an additional 1,286, or 34/day over the past 38 days. This is down substantially from the June report, when it averaged a whopping 179/day.

For the entire off-season period, MNsure has added 11,533 QHP selections, or an average of 68 per day. Extrapolated out nationally, that would be about 10,300 per day nationally, although in prior years off-season SEPs have averaged between 7,000 - 9,000 per day.

Avik Roy is a well-known conservative, anti-ACA healthcare pundit, writer and advisor. As the article I link to below describes him:

Avik Roy is a Republican’s Republican. A health care wonk and editor at Forbes, he has worked for three Republican presidential hopefuls — Mitt Romney, Rick Perry, and Marco Rubio. Much of his adult life has been dedicated to advancing the Republican Party and conservative ideals.

Regular readers know that he and I have butted heads several times in the past:

Just a little while ago I reminded folks about's OFF-exchange Plan Finder, which very few people seem to be familiar with.

Just moments ago, the CMS division of HHS announced a complete overhaul/update to their already-existing searchable Hospital Compare database, which appears to be basically a Yelp for hospitals. From today's CMS blog post:

This is a quick be honest, it's mainly here just to remind myself to refer to the link again for a later project. But I just wanted to remind everyone that in addition to the exchange-based Qualified Health Plan listings at HealthCare.Gov (which cover 38 states) and the rate review database where you can search through the proposed (and, eventually, approved) rate hikes for every ACA-compliant individual or small group policy by carrier, there's also a third database: The Plan Finder.

Welcome to Plan Finder

This Plan Finder website is provided by the federal government to help you find private health plans available outside the Health Insurance Marketplace. We want you to find health insurance that best fits your budget and meets your needs.

Sara Hansard of Bloomberg News reports on an interesting tidbit for #OE4:

Getting subsidies for Affordable Care Act health plans is about to become easier.

Additional verification of eligibility will only be required if the difference between stated income and Internal Revenue Service or Social Security data is at least 25 percent, or $6,000, underguidance from the Department of Health and Human Services.

Currently, additional verification is required if the discrepancy is only 10 percent or greater.

The change, which is for the 2017 plan year, “will reduce the number of consumers who have to follow-up and submit documentation to verify their household income while maintaining important program integrity controls,” the Centers for Medicare & Medicaid Services said in the guidance.

I hereby admit that a) I don't know much about Medicare (remember, my major focus is on the ACA exchanges, Medicaid expansion, the individual/small group market and so forth) and b) I'm swamped at the moment so don't have time to do a real analysis/write-up on today's announcement, but it appears to be a Pretty Big Deal, so I'll just present the press release/statement for the moment:

U.S. Department of Health & Human Services • Monday, July 25, 2016 • News Release • 202-690-6343

Important Next Step towards a Better, Smarter, Healthier Medicare:
New Payment Models and Rewards for Better Care at Lower Cost

Today, the Department of Health & Human Services proposed new models that continue the Administration’s progress to shift Medicare payments from quantity to quality by creating strong incentives for hospitals to deliver better care to patients at a lower cost. These models would reward hospitals that work together with physicians and other providers to avoid complications, prevent hospital readmissions, and speed recovery.


CMS approves Arizona’s plan to re-open CHIP program

Today, the Centers for Medicare & Medicaid Services (CMS) announced that it has approved Arizona’s plan to allow new enrollment in the Children’s Health Insurance Program (CHIP) after enrollment was frozen for several years. Now all states provide CHIP coverage to eligible children. 

“Today’s approval is a step forward for the health of Arizona children in low-income families,” said Vikki Wachino, CMS Deputy Administrator and Director of the Center for Medicaid and CHIP Services. “With Arizona’s decision, all states in the nation now provide CHIP coverage to any eligible child who applies. More children in Arizona will have access to coverage early in their lives, which helps kids grow into healthy adults and provides parents with the peace of mind that comes from their children having affordable coverage.”

Having coverage through CHIP improves children’s health and increases their ability to succeed in school. Recent research on Medicaid and CHIP shows that these gains are long lasting, with children who gained coverage experiencing better health, higher educational attainment, and higher earnings as adults.

(Originally Posted 6/09/16)

Every year, Republicans insist that the ACA is guaranteed to cause a rate hike "death spiral" as increasing premiums cause healthier people to drop out of the individual exchange market, causing higher medical expenses, causing even higher premiums, causing more healthy people to drop out and so forth...and every year, for three years in a row so far, this has failed to be the case nationally. While premiums have obviously continued to increase for many people, the individual insurance market has grown each year, from around 11 million in 2013 to 15.6 million in 2014, around 17 million last year and up to 19-20 million or so today.

IMPORTANT: This is really just a placeholder for Georgia's 2017 average rate hike requests, because it's extremely spotty and partial so far. I'll update it once I'm able to actually track down the bulk of Georgia's individual market enrollment and rate hike request numbers.

UPDATE 7/25/16:  I've managed to acquire the additional filings; see update below