Regular readers may have noticed that I haven't checked in on the status of #BidenCare (aka #ACA 2.0) since way back in early August. There's several reasons for this: At first I was swamped with my COVID vaccination/case/death rate project; then, more recently, I had to scramble to get my annual Rate Change project up to date.
Both of these have indeed monopolized my time, but the main reason is simply that President Biden's Build Back Better (BBB) plan (which ACA 2.0 is a part of) has gotten bogged down over the past few months due to infighting and intransigence by a handful of "moderate/centrist" Democrats in the House but especially by two Democratic Senators in particular (Joe Manchin of West Virginia and Kyrsten Sinema of Arizona).
(Needless to say, I'm not even mentioning any Republicans in either the House or Senate, since not a single one of them is willing to support the bill.)
It seemed a bit pointless to write up a lengthy, in-depth analysis of the latest developments on the bill when what does or doesn't have a serious shot at making the final cut kept changing every few days.
Here's the weekly look at the rate of COVID-19 cases & deaths at the county level since the end of June, broken out by partisan lean (i.e, what percent of the vote Donald Trump received in 2020).
The case rate is pretty much the same as it was last week, with new cases running 3x higher per capita in the reddest tenth of the country than the bluest tenth...
I go by FULLY vaccinated residents only (defined as 2 doses of the Pfizer or Moderna vaccine or one dose of the Johnson & Johnson vaccine).
I base my percentages on the total population, as opposed to adults only or those over 11 years old.
For most states + DC I use the daily data from the Centers for Disease Control, but there are some where the CDC is either missing county-level data entirely or where the CDC data is less than 90% complete at the county level. Therefore:
For California, I'm using the CDC data for most counties and the state health dept. dashboard data for the 8 small counties which the CDC isn't allowed to post data for.
Every year, I spend months painstakingly tracking every insurance carrier rate filing for the following year to determine just how much average insurance policy premiums on the individual market are projected to increase or decrease.
Carriers tendency to jump in and out of the market, repeatedly revise their requests, and the confusing blizzard of actual filing forms sometimes make it next to impossible to find the specific data I need. The actual data I need to compile my estimates are actually fairly simple, however. I really only need three pieces of information for each carrier:
I can't overstate how much I wish every state was as good as Pennsylvania is at not only making their annual rate filings publicly available on the state insurance dept. website, but doing so in such a clear, simple format, while also including a consistent summary page for every carrier!
As a result of this attention to transparency and detail, I was able to put together my Pennsylvania analysis pretty quickly even though they hae a huge number of carriers on both their individual and small group markets.
Aside from Cigna joining the PA indy market, not too many surprises in the Keystone State this year...approved average indy market premiums are staying nearly flat overall (+0.2%), while small group plans will cost around 4.8% more than last year on average.
Texas' annual health insurance rate filings are kind of a mixed bag in terms of transparecy. Hardly any of the carriers have Uniform Rate Review Template (URRT) forms or Rate Filing Justification Form Part II available (these are the documents which generally include the actual number of people enrolled in the policies for each market for that insurance carrier), and the Actuarial Memorandum (Part III) is heavily redacted for most of them, making it very difficult to lock in the actual enrollment numbers.
On the other hand, a few of them do offer one or both of the former documents, and in a few cases I was able to get the policyholder figures via the SERFF database. I'm operating on the assumption that each individual market policy has roughly 1.5 covered lives apiece on average.
Unfortunately, without having even that estimate available for half the carriers offering policies in Texas, I can't run a weighted average increase (it comes to +4.9% using what I have available), so I'm left (once again) with an unweighted average of around +1.5% on the individual market and +6.1% for small group policies.
There are 9 states where I've been unable to track down the actual enrollment data for individual market carriers. North Dakota is among them.
The unweighted average rate increase for 2022 is 6.0% for the ND individual market and 5.3% for the small group market, which consists of the same three carriers (UnitedHealthcare was a fourth participant in ND's small group market in 2021, but they aren't listed in the federal Rate Review database as of this writing, so I'm assuming they're pulling out).
Virginia has an extremely robust, competitive individual & small group insurance market...and in 2022 it's getting even more competitive, with three new carriers joining the individual market: Aetna, Bright and Innovation Health Plan.
Beyond that, I don't see any shocking or dramatic developments for 2022; average unsubsidized individual market premiums are dropping by 2.9% statewide, while average small group premiums are increasing by 3.6% overall.
West Virginia has the second-smallest ACA individual market enrollment total (Alaska has the smallest), while also being one of the only states left which has (until 2022) refused to use #SilverLoading in their premium pricing strategy to provide some relief to moderate-income indy market enrollees.
As a result of this and other factors, they now have the highest unsubsidized individual market policy premiums in the country (19% higher than the prior record-holder, Wyoming, which averaged $870/month in 2021), at $1,038/month per enrollee.
In 2022, this is gonna be even more jaw-dropping, as the approved rate increases for WV's carriers will average 12.8%, bringing the average premium up to a whopping $1,171/month per person.
I'm pretty sure Wisconsin has the most competitive ACA markets in the country, at least in terms of the sheer number of insurance carriers offering policies on both the individual and small group markets. A total of 37 are present at the moment, although 5 of the small group carriers don't appear on the federal Rate Review database as of yet.
Unfortunately, this is yet another state where the enrollment data has basically been buried, so I can only run unweighted average rate changes.
With that in mind, the individual market rates look to be nearly flat (dropping by 0.8% on average), while small group plans are going up 4.4%.
