2020 OPEN ENROLLMENT ENDS (most states)

Time: D H M S

Charles Gaba's blog

Back in March I wrote an analysis of H.R.1868, the House Democrats bill which comprises the core of the larger H.R.1884 "ACA 2.0" bill. H.R.1884 includes a suite of about a dozen provisions to protect, repair and strengthen the ACA, but the House Dems also broke the larger piece of legislation down into a dozen smaller bills as well.

Some of these "mini-ACA 2.0" bills only make minor improvements to the law, or in ways which are important but would take a few years to see obvious results. Others, however, make huge improvements and would be immediately obvious, and of those, the single most dramatic and important one is H.R.1868.

The official title is the "Health Care Affordability Act of 2019", but I just call both it and H.R.1884 (the "Protecting Pre-Existing Conditions and Making Health Care More Affordable Act of 2019") by the much simpler and more accurate moniker "ACA 2.0".

Back in March I wrote an analysis of H.R.1868, the House Democrats bill which comprises the core of the larger H.R.1884 "ACA 2.0" bill. H.R.1884 includes a suite of about a dozen provisions to protect, repair and strengthen the ACA, but the House Dems also broke the larger piece of legislation down into a dozen smaller bills as well.

Some of these "mini-ACA 2.0" bills only make minor improvements to the law, or in ways which are important but would take a few years to see obvious results. Others, however, make huge improvements and would be immediately obvious, and of those, the single most dramatic and important one is H.R.1868.

The official title is the "Health Care Affordability Act of 2019", but I just call both it and H.R.1884 (the "Protecting Pre-Existing Conditions and Making Health Care More Affordable Act of 2019") by the much simpler and more accurate moniker "ACA 2.0".

I talked about this the other day, but re-reading my post, I don't think I emphasized it nearly enough:

It's also important to keep in mind that due to how the ACA's subsidy formula is structured (combined with Silver Loading and Silver Switching), a lower benchmark premium will actually result in higher net premiums for many subsidized enrollees (although it's still good news for those who are unsubsidized). Here's why:

  • Let's say the unsubsidized premiums for a given enrollee in 2019 is $400 for Bronze, $600 for the benchmark Silver and $700 for Gold.
  • Let's say that enrollee earns exactly $32K/year (256% FPL), meaning they only have to pay 8.54% of their income for the benchmark plan.
  • That means they qualify for ($7,200 - $2,733) = $4,467 in subsidies ($372/month).

This would leave them paying $228/month for the benchmark Silver...but they can apply that towards a Bronze plan if they wish so they'd only pay $28/month, or a Gold plan so they only pay $328/month.

A week or so ago I  noted that several of the 13 state-based exchanges (remember, Nevada split off of HC.gov this year) had opened up their ACA exchange websites for prospective enrollees to window shop for 2020 coverage. One of them, Covered California, actually started allowing people to enroll already; the rest were for comparison shopping only.

Well, as of today, residents of every state can window shop for 2020 healthcare policies, because HealthCare.Gov has followed suit and is now letting you plug in your household & income info to see what plans are available next year, what the unsubsidized premiums are, and (most importantly for a lot of people) what sort of financial assistance you may be eligible for.

There have been some interesting modifications to the interface and workflow of HC.gov this year:

FEDERAL HEALTH INSURANCE EXCHANGE 2020 OPEN ENROLLMENT 

OK, I know, I know, I'm obsessing over this and I promise to stop soon.

Yesterday I noted that due to a surreal, Rube Goldberg-esque series of events dating back to a different lawsuit filed back in 2014 by then-Speaker of the House John Boehner (!), it's looking very likely that the federal government will have to shell out at least $1.6 billion in Cost Sharing Reduction (CSR) reimbursement payments to over 100 health insurance carriers even though those carriers have already made up most of their losses elsewhere in the form of increased premium rates.

As I've noted several times recently, the "break off of HealthCare.Gov & establish your own state-based ACA exchange" train continues to pick up steam, with the following states having committed to either firing up their own, separate exchange website platform or at the very least going halfway by establishing their own exchange entity (which includes a board of directors, their own marketing/outreach budget, the ability to dictate which plans are allowed onto the exchange and so forth) if they haven't already done so.

OK, bear with me.

First, I want you to click this link and read this long, wonky post from back in February about the ongoing CSR class action lawsuit saga and the potential consequences. I'll wait right here.

OK, done reading it?

For those of you too impatient to read the backstory, here's the VERY short version:

 

Just 9 days ahead of the official launch of the 2020 ACA Open Enrollment Period (California already started theirs), the House Energy & Commerce Health Subcommittee will be holding a livestreamed hearing with CMS Administrator Seema Verma:

HEARING ON "SABOTAGE: THE TRUMP ADMINISTRATION'S ATTACK ON HEALTH CARE"

  • Date: Wednesday, October 23, 2019 - 10:00am
  • Location: 2123 Rayburn House Office Building
  • Subcommittees: 116th Congress, Energy and Commerce (116th Congress), Oversight and Investigations (116th Congress)

The Subcommittee on Oversight and Investigations of the Committee on Energy and Commerce will hold a hearing on Wednesday, October 23, 2019, at 10 a.m. in the John D. Dingell Room, 2123 of the Rayburn House Office Building.

I've been expecting this exact press release from Trump's HHS Dept. to drop for awhile now:

Premiums for HealthCare.gov Plans are down 4 percent but remain unaffordable to non-subsidized consumers

Today, the Centers for Medicare & Medicaid Services (CMS) announced that the average premium for the second lowest cost silver plan on HealthCare.gov for a 27 year-old will drop by 4 percent for the 2020 coverage year. Additionally, 20 more issuers will participate in states that use the Federal Health Insurance Exchange platform in 2020 bringing the total to 175 issuers compared to 132 in 2018, delivering more choice and competition for consumers. As a result of the Trump Administration’s actions to stabilize the market, Americans will experience lower premiums along with greater choice for the second consecutive year.

It is with profound grief that I announce that our beloved german shepherd Bella, the best, most wonderful, most gentle good girl in the world, died suddenly this morning at around 11am. She was only 9 years old.

The vet told us she had a pericardial effusion caused by a hemangiosarcoma...an aggressive, cancerous tumor near the heart with no advance signs which likely ruptured in the middle of the night, causing bleeding & fluid to build up in turn leading to vomiting and death.

Apparently there was no way for a veterinarian to detect it until it actually burst unless they knew it was there already. She seemed perfectly fine last evening. At around 2:30am she vomited & defecated profusely.

She seemed better after that...was drinking water and responding pretty well. We decided to see how she was in the morning & take her to the vet if necessary. This morning she was sleeping deeply but seemed to be breathing OK.

A little bit later, though, she took a turn for a worse. We rushed her to the emergency animal clinic up the road. I think she died as we were pulling up. The only 'positive' is that the vet said bringing her in a few hours earlier wouldn't have made any difference.

I haven't written about it in a few weeks, but the ruling from the 5th Circuit Court of Appeals could (and likely will) be released any day now, so it's a good thing that Abby Goodnough wrote this piece for the New York Times today:

How Pending Decision on Obamacare Could Upend 2020 Campaign

A federal appeals court’s ruling on the Affordable Care Act could be a huge headache for the president and take Democrats’ focus off Medicare for all.

A federal appeals court in New Orleans is preparing a ruling on the Affordable Care Act that could put the law’s future front and center in the presidential race, overwhelming the current Democratic debate over Medicare for all and reigniting the health care-driven worries that helped Democrats win back the House last year.

I noted yesterday that Virginia is the latest state to consider jumping onboard the State-Based Exchange train, joining Nevada, New Mexico, New Jersey, Pennsylvania, Maine and possibly Oregon in making the move. Every time I've mentioned Oregon, however, I've had to put a bit of an asterisk on it because I wasn't quite sure whether or not their shift back to their own full tech platform was still a go or not.

Like Nevada, Oregon did have their own full exchange once upon a time. Back in the first ACA Open Enrollment Period from 2013-2014, both states were among those which ran their own exchange websites. Nevada's was developed by Xerox; Oregon's was developed by Oracle.

Back in early August, I ran the preliminary average unsubsidized 2020 individual market rate changes in Arizona. At the time, I had the requested rate changes for both the individual and small group markets, but not the actual enrollment numbers for each carrier, so I had no way of calculating the weighted average. I instead settled for a simple unweighted average, which came in at around a 2.4% reduction in premiums on the individual market and a 5.2% increase on the small group market.

A few days ago, the Arizona Insurance Dept. released the final/approved 2020 rate changes, and there was only one significant change: Health Net of AZ (dba Arizona Complete Health), which had requested a 2.9% rate reduction, will instead be keeping their premiums flat year over year on average. With Health Net holding over 50% of the market share, this meant that the statewide average is a bit higher than I had it previously.

Believe me, I was certain that I had finally gotten this year's Medical Loss Ratio (MLR) rebate project out of my system. I really was.

However, there was one other MLR-related issue which I've wondered about for years: The ACA requires that carriers who sell policies in the Individual and Small Group markets spend at least 80% of the premium revenue on actual medical claims (limiting them to a 20% gross margin), and 85% on the Large Group market (limiting them to 15% gross).

That accounts for around 165 million people, give or take...roughly 50% of the total U.S. population...but what about the other private (or at least semi-private) insurance markets? I'm referring, of course, to privately-administered Medicare and Medicaid plans...aka Medicare Advantage and Managed Care Organizations (MCOs).

It took me a couple of days to post this, but it's an important development, especially on the cusp of the Virginia legislative election next month which could flip both the state House and Senate to the Democrats; thanks to Esther Ferington for the heads up:

Governor Northam Signs Executive Directive to Ensure Access to Affordable, Quality Health Care Coverage for All Virginians

RICHMOND—Governor Ralph Northam today issued Executive Directive Five, directing actions to increase the number of Virginians enrolled in quality, affordable health care coverage.

This year, Medicaid expansion is providing access to health coverage for more than 325,000 eligible Virginians who have enrolled, positively impacting their health. But meaningful health coverage remains unaffordable for too many Virginians, due in large part to federal policies that have increased cost and decreased the quality of available coverage.

Pages