Charles Gaba's blog

The big story in the 2017 Risk Adjustment report from CMS over the weekend is, of course, the fact that CMS has decided to freeze $10.4 billion in revenue transfers (or $5.2 billion, depending on your POV) in response to a judgicial ruling in a New Mexico lawsuit.

However, before the actual table breaking out all the carriers by state and how much each owes/is owed, the report includes some other interesting wonky data stuff about 2017 enrollment. Most of it wasn't of much interest to me, but one bar graph caught my eye:

I've obviously gotten a bit behind with my "ACA 2.0 spreadsheet" project...

New law preserves Affordable Care Act measures for Hawaii residents

Gov. David Ige signed a new law on Thursday that ensures certain benefits under the Affordable Care Act will be preserved under Hawaii law.

Senate Bill 2340 retains several of the measures introduced in the Obama-era legislation, also known as Obamacare, including a clause that allows Hawaii adults up to 26 years-old to continue receiving health insurance under their parents.

The law also prohibits health insurance organizations from excluding coverage to those with preexisting conditions, or using an individual's gender to determine premiums or contributions to health insurance plans.

According to Louise Norris of healthinsurance.org, here's a more clear look at what SB 2340 does:

I admit to not knowing a whole lot about how Maryland's "All-Payer" system works aside from every payer (Medicare, Medicaid, private insurance) having to pay the same amount for the same services at a given hospital. Here's a general summary from Wikipedia:

All-payer rate setting is a price setting mechanism in which all third parties pay the same price for services at a given hospital. The system does not imply that charges are the same for every hospital. It can be used to increase the market power of payers (such as private and/or public insurance companies) to mitigate inflation in health care costs. All-payer characteristics are found in the health systems of France, Germany, Japan, and the Netherlands. Maryland also uses such a model.

This morning, CMS released the 2017 Risk Adjustment Summary Report for the Individual, Catastrophic and Small Group markets. As I noted at the time, the total amount of money we're talking about being shifted around here is around $10.4 billion, with around $7.5 billion in the individual market, $2.9 billion in the small group market and just $42 million in the catastrophic market.

However...this isn't actually a matter of insurance carriers being owed $10.4 billion. Because of how Risk Adjustment (RA) works, it's actually half as much as that--around $5.2 billion is owed by some carriers to other carriers.

OK, this is very helpful! via the Robert Wood Johnson Foundation:

A year ago, rate filings caused widespread anxiety, as multiple carriers announced withdrawals from the ACA market, and state officials struggled to fill bare counties. Many of those remaining filed enormous rate increases. In 2018, marketplace enrollment was stable, while unsubsidized enrollment continued its multi-year decline. So far, this year’s rate filing season has been sprinkled with news of entry and expansion, and proposed rate hikes that are generally more moderate. With no announced market exits thus far, it seems likely that in 2019 there will be net entry into the ACA marketplace.

...Our public web tool tracks participation for 2019 at the county level. It can be used to monitor changes in the number of carriers by counties, and also provides information at the carrier level. Data can also be downloaded.

Over the weekend, CMS dropped a big bombshell on everyone: In response to a federal judge siding with a small insurance carrier in New Mexico in a lawsuit over the formula for the ACA's Risk Adjustment (RA) formula, the Trump Administration has decided not to transfer any RA funds for the 2017 calendar year to anyone until...well, I'm not sure exactly, but for the foreseeable future.

Pretty much expert on how the RA program (and the law) has indicated that this is completely unnecessary; there's several responses at CMS's disposal which wouldn't require throwing the entire industry into a panic (yet again). Regardless, this is where we're at.

OK, I wasn't expecting this at 10:40pm on a Friday night, but here you go...via Stephanie Armour and Anna Wilde Mathews of the Wall St. Journal:

Trump Administration Expected to Suspend ACA Program Related to Insurer Payments

The Trump administration is expected to suspend an Affordable Care Act program that plays a key role in the health law’s insurance markets, a move that could deal a financial blow to many insurers that expect payments.

The suspension of some payouts under the program, known as risk adjustment, could come in the wake of a recent decision by a federal judge in New Mexico, who ruled that part of its implementation was flawed and hadn’t been adequately justified by federal regulators, people familiar with the plans said.

A few days ago, the Centers for Medicare & Medicaid released three important new reports on the 2018 Open Enrollment Period and trends in the individual market. There's a lot of data to go over, so I'm breaking my analysis into several smaller posts for easier readability.

OverviewPart OnePart TwoPart ThreePart Four

Now we move onto the second report released by CMS this week: The "Subsidized/Unsubsidized Enrollment Trend Report". If you set aside the anti-ACA digs from the Trump Administration, there's some fascinating data to be found, including what they claim to be one of the Holy Grails of the ACA individual market: Supposedly accurate data on the number of off-exchange ACA-compliant enrollees across the first four years of the ACA exchanges! Yes, I know, it's exciting, heady stuff.

A few days ago, the Centers for Medicare & Medicaid released three important new reports on the 2018 Open Enrollment Period and trends in the individual market. There's a lot of data to go over, so I'm breaking my analysis into several smaller posts for easier readability.

OverviewPart OnePart TwoPart ThreePart Four

Next, let's take a look at the average unsubsidized monthly premiums and APTC subsidies in each year. I've already crunched all of these data before, but that was based on the QHP selctions from the 2017 and 2018 Open Enrollment Periods. The table below is more accurate since it reflects the actual average premiums and subsidy amounts for all of 2017 and for 2018 after subtracting out nearly all of those who never actually paid for their first month of coverage. The numbers for each state and nationally should be close but slightly different:

A few days ago, the Centers for Medicare & Medicaid released three important new reports on the 2018 Open Enrollment Period and trends in the individual market. There's a lot of data to go over, so I'm breaking my analysis into several smaller posts for easier readability.

OverviewPart OnePart TwoPart ThreePart Four

OK, next up: HOW MANY HAVE PAID???

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