A couple of weeks ago, I crunched the numbers from a major state-by-state study by the Milliman actuarial firm and concluded that the overall individual market was somewhat smaller than I had previously thought, and was likely around 17.7 million people total as of today. The key thing to keep in mind is that the enrollment numbers can fluctuate quite a bit over the course of the year due to the high churn rate and other factors. As a result, the average annual enrollment can be quite different from the snapshot in time total.
If you enroll in an ACA exchange policy via HealthCare.Gov (or any of the state-based exchanges), you have three options for the Advance Premium Tax Credits:
You can decline to even see if you're eligible (if your income is high enough that you're certain that you won't qualify)
You can see if you're eligible, and if so, choose to apply some or all of the APTC directly to your monthly premium
You can see if you're eligible, and if so, choose not to apply any of the APTC to your monthly premium, choosing instead to pay full price up front and then receive the full annual tax credit when filing your taxes the following year.
Well THAT figures: Insurance carriers finally breaking even on ACA exchanges just in time for GOP to tear up the law.
Health insurers may finally be seeing improved results on their Obamacare plans just as a newly elected president is poised to follow through on promises to end the controversial coverage program, a new report suggests.
An analysis out Thursday says that health insurers are expected in 2016 "to start reversing" financial losses on their Obamacare business after "hitting bottom" in 2015.
And 2017 "will likely see continued improvement" for those insurers selling individual health plans, "with more insurers getting close to breakeven or better," according to the report by Standard and Poor's Global Ratings.
Last year Virginia was the first state out of the gate with their initial 2017 individual & small group market rate filings. I'm not sure if this is chance or if they simply have the earliest filing deadline. I'm guessing the latter, because, as Zach Tracer noted earlier today, Virginia is again the first state to list their 2018 Individual and Small Group Market participants. Remember, these are initial filings only, and very much subject to change throughout the summer and early fall. Here's who Tracer says has stated is committing to being on the ACA exchanges this fall...at the moment, anyway:
UPDATE: ...or, perhaps not. Latest word is that there's basically little to see here; lots of big talk about pushing forward but very little action. Or perhaps there will be next week, who the heck knows? Wash, rinse, repeat.
As far as I can tell, even the amazing Louise Norris hasn't caught this one yet (and it's a month old, too!). If I'm wrong and she has done a write-up on it, of course, I'll eat my words:
Medicaid for all
Democratic [Nevada] Assemblyman Mike Sprinkle has introduced a bill, AB374, to open up the state’s Medicaid program to anyone, regardless of their income level.
Individuals would be able to purchase coverage through Medicaid on the healthcare exchange for an annual premium set at 150 percent of the median expenditure paid on behalf of Medicaid enrollees in the preceding fiscal year. Though none of the current federal or state dollars going to fund Medicaid would be used to cover any portion of the new enrollees, they would still be entitled to the same benefits provided to other Medicaid recipients.
If you can't hear it, here's the transcript of California Democratic U.S. Senator Diane Feinstein's response when asked how (not if, mind you...how) she would support moving to a Single Payer healthcare system:
She starts out by making an incredibly tone-deaf and inaccurate statement about single payer:
"If by ‘single payer’ you mean that it’s going to be a complete takeover by the government, of healthcare, then I am not there.
As most people know by now (well, most people in Tennessee, anyway), Humana decided a full two months ago to bail on the entire individual market, across the board--every state, both on and off the exchange, the works. This stung in quite a few counties across 11 different states, but the one which everyone is freaking out about is Tennessee...because there are 16 counties where Humana was the only carrier participating on the ACA exchange. Here's the list of Tennessee counties Humana is available in this year; note that there's an additional 14 counties where there's one other carrier available at the moment.
As of 2017, Hawaii no longer has a SHOP exchange for small businesses. The State Department of Labor and Industrial Relations has an FAQ page about this.
...Hawaii’s waiver aligns the ACA with the state’s existing Prepaid Health Care Act. Under the Prepaid Healthcare Act, employees who work at least 20 hours a week have to be offered employer-sponsored health insurance, and can’t be asked to pay more than 1.5 percent of their wages for employee-only coverage (as opposed to 9.69 percent under the ACA in 2017).
...and then went on to conclude that, given the insane amount of uncertainty and confusion about what Donald Trump, Tom Price and the Congressional GOP in general has in mind for the 2018 insurance market, on top of normal stuff like inflation, an aging population and so on, that there are five likely scenarios:
Now, put yourself in the position of an insurance carrier executive and/or one of their actuaries. The level of uncertainty in the air is mind boggling. You have five choices for your initial filing:
For all the details, see this piece by Jonathan Cohn; the short version is that, if Trump does this, premiums could skyrocket and insurers could flee the individual markets, causing them to melt down and ultimately pushing millions off coverage. As Cohn notes, Trump is basically “threatening to torpedo insurance for millions of Americans unless Democrats agree to negotiate with him.”
The Trump administration says it is willing to continue paying subsidies to health insurance companies under the Affordable Care Act even though House Republicans say the payments are illegal because Congress never authorized them.
The statement sends a small but potentially significant signal to insurers, encouraging them to stay in the market.
In additon to color-coding their data by the political party of each District's Representative, I'm also adding my own spin on the data: Estimates of how many people currently enrolled in the individual market suffer from "pre-existing conditions" which would likely mean them either being denied coverage altogether if the ACA's Guaranteed Issue, Essential Health Benefits and Community Rating provisions were to be stripped (Alternately, these people would charged massively higher rates to the point of likely not being able to afford the policy).