Time: D H M S

OK, so this is what the "Three-Legged Stool" of the ACA is supposed to look like for the individual market:

Of course, I say "supposed to" because two of the three legs are simply too short, causing it to lean over somewhat.

June 13, 2017: CMS releases the following propaganda press release:

County by County Analysis of Current Projected Insurer Participation in Health Insurance Exchanges

The Centers for Medicare & Medicaid Services (CMS) is releasing a county-level map of 2018 projected Health Insurance Exchanges participation based on the known issuer participation public announcements through June 9, 2017. This map shows that insurance options on the Exchanges continue to disappear. Plan options are down from last year and, in some areas, Americans will have no coverage options on the Exchanges, based on the current data.

Back on November 15, 2016, one week after the election, I posted the following:

IMPORTANT: I cannot guarantee accurate federal data after 1/20/17.

...Most of the actual staff...the career employees at CMS/HHS, many of who've been there through more than one administration, will likely remain, and will do their jobs to the best of their ability, including trying to compile and publish data as accurately as possible.

HOWEVER, their bosses...the HHS Secretary and, I presume, the head of CMS...will be appointed by Donald J. Trump and confirmed by a 100% Republican-controlled Senate.

Given Trump's long, disturbing history of flat-out misstatements (aka "making sh*t up out of whole cloth"), and the type of sycophants he's likely to put into place, I can't guarantee with any certainty that the numbers spouted off by them are going to bear any connection with reality. Maybe they'll be accurate. Maybe they'll be off slightly. Maybe they'll be completely removed from any actual numbers. Who the hell knows?

An eternity ago (aka back in January/February), I attempted to compile and break out estimates of how many people would likely lose healthcare coverage in the event of a full, "clean" repeal of the Affordable Care Act (that is, a complete repeal of the ACA without any replacement healthcare policy whatsoever). I concluded that the total added up to roughly 24 million people nationally: Around 8.2 million highly-subsidized Individual Market enrollees, nearly 15 million Medicaid expansion enrollees and 750,000 Basic Health Plan enrollees (NY & MN only). I then attempted to break these out by both County and Congressional District​. I went with a "clean" repeal because there wasn't any actual replacement plan available to compare with.

Things are looking pretty precarious in Iowa for 2018, with Wellmark and Aetna bailing entirely on the state's individual market.

The good news, such as it is, is that Medica has stepped up to the plate as the sole insurance carrier filing to offer indy market policies (on the ACA exchange or off, I believe) across all 99 counties next year.

The bad news--although I can't really say that I blame them under the circumstances--is that they're insisting that they'll need a big rate hike to do so.

Here's the thing, though: First check out the headline in this story about it from The Hill:

Only ObamaCare insurer in most Iowa counties to hike premiums by 43.5 percent

One of the last insurers on Iowa's ObamaCare exchanges announced Monday it would sell plans in 2018 but proposed an average rate increase of 43.5 percent.

Earlier this year, in response to popular demand, I put together an extensive list of serious proposals to actually repair, improve and strengthen the ACA itself, as opposed to a) tearing it apart and replacing it with the GOP's Godawful pile of crap or b) tearing it apart and attempting to replace it with a total single payer system (which simply is not going to happen in the near future no matter what).

I came up with some of these ideas on my own (though I'm sure others have made similar suggestions), but most of them have been widely discussed by various heatlhcare wonks over the past few years. Some would require additional funding, but others are simply regulatory and wouldn't cost a single state or federal dime.

One of these seems to be catching on pretty quickly...number 12:


h/t to Rebecca Stob for the heads up:

OLYMPIA, Wash. - Eleven health insurers filed 71 health plans for Washington state’s 2018 individual and family health insurance market, with an average proposed rate increase of 22.3 percent. No health insurer filed plans in two counties – Klickitat and Grays Harbor.

Insurance Commissioner Mike Kreidler has been reaching out to insurers since they filed their plans on June 7 to see if one or more will reconsider offering plans in the bare counties.

“I’m very concerned by the proposed changes we’re seeing,” Kreidler said. “I know these numbers will be extremely upsetting to people who buy their own health insurance. They’re upsetting to me. We’re going to spend the next several months reviewing every assumption insurers have made to make sure their proposed increases are justified.

OK, this was a bit unexpected.

Last week I analyzed the monthly enrollment effectuation numbers through all 4 years of ACA Open Enrollment (2013 - 2017), to help visualize how the enrollment numbers flow throughout the year (and to also show how misleading the Trump CMS "attrition" report from last week was).

Then, on Thursday, I wrote about a CMS powerpoint presentation from last year which provided a Holy Grail of sorts for me: Not only did it provide the monthly effectuation numbers for 2015, it broke them out by starting and ending month. That is, it divided the numbers into how many enrollees for that month had originally enrolled starting in January, in February and so forth. This is really, really important because having "an average" of 100,000 enrollees each month doesn't mean much if it's a different 100,000 people every month--that is, if a lot of people are signing up, having expensive treatments and then dropping out and then replaced by someone else, that hurts the risk pool, since the original batch aren't paying for the other months of the year when they don't require treatment.

As regular readers know, I've been a bit obsessive about tracking down and breaking out ACA Medicaid expansion enrollee numbers. This is more difficult than it sounds, because most Medicaid reports lump expansion enrollees in with the other ~58 million or so Medicaid enrollees; only a handful of states issue separate reports of the expansion-specific population on a regular basis.

Back in late November, I cobbled together the data as best as I could and came up with a total of roughly 11.3 million people nationally. However, that included a lot of 2-year old data and rough estimates.

A couple of weeks later, I stumbled upon a detailed analysis from an anti-ACA financial watchdog organization, the Foundation for Government Accountability, which provided hard numbers and confirmable data source links which included more recent numbers for many states. This brought the total up to over 12.3 million.

OK, all sorts of craziness happening, I've been swamped with stuff, so here's a quick roundup:


Health insurer Centene Corp. plans a broad expansion of its Obamacare offerings next year at a time when many of its big rivals are retreating from the program.

Centene said Tuesday that it would sell Affordable Care Act plans in three additional states: Kansas, Missouri and Nevada. The company also said it will expand in six states where it already offers Obamacare plans.

“Centene recognizes there is uncertainty of new health-care legislation, but we are well positioned to continue providing accessible, high quality and culturally-sensitive health-care services,” Chief Executive Officer Michael Neidorff said in the statement.

The company specializes in providing Medicaid coverage for low-income people, and has said the skills it’s honed in that business have helped make it successful in Obamacare markets.

For heaven's sake. Here I sit, painstakingly digging up, downloading, compiling and analysing a mountain of 2018 SERFF rate filing forms for hours on end to find out what the weighted average requested rate hikes are in every state and to then go beyond that to figure out how much of the increases are due to normal factors vs. Trump/Price/GOP-specific sabotage efforts such as the threat to cut off CSR payments and/or not to enforce the individual mandate penalty...

...and then a big healthcare consulting firm like Oliver Wyman goes and steals my thunder by issuing hteir own analysis:

Two market influences, in particular, are complicating 2018 rate setting: the uncertainty surrounding continued funding of cost sharing reduction (CSR) payments and the question of how the relaxation of the individual mandate will impact enrollment and risk pools.


Earlier this week I busted the Trump Administration's CMS division for releasing a misleading report which tried to understate the enrollment retention rate of ACA exchange enrollees. I'm not entirely sure why they did this, since even their "fudged" number wasn't really that much worse than previous years (they tried to make itt look like a March attrition rate of 15.4% vs. the 12.8% and 12.6% from 2015 and 2016 respectively), but for whatever reason, they did so. The short version is that they only included enrollees who paid for their January and February policies instead of also including those who paid their March premiums, as was done in previous years. As far as I can figure, the actual 3/31/17 effectuation rate closer to 11.8%, a slight improvement over 2015 and 2016, though I can't be certain about this without knowing how many of the ~500,000 people who signed up in the last 2 weeks of January paid and were effectuated for March coverage.

The Centers for Medicare & Medicaid Services is administered by Trump/Price pick Seema Verma, who is openly doing everything possible to trash the ACA and push the AHCA, to the point of allegedly committing borderline extortion in order to help push it through.

Therefore, this came as a bit of as surprise a few days ago (yeah, I'm late to the party on this one...busy week). The lead actuary for CMS, Paul Spitalnic, issued his own scoring of the impact of the AHCA on healthcare coverage, premiums and the federal budget.

It's important to note--as Mr. Spitalnic himself does right at the top of the analysis--that:

Calculating the average requested rate hike in Delaware is easier than most states. This year they officially have 5 carriers participating in the individual market (3 on exchange, 2 off)...but one of those is "Freedom Life" which is a phantom carrier; another is Golden Rule which only has about 120 enrollees; and two of the others are divisions of Aetna, which is dropping out of Delaware's indy market next year altogether. That leaves just Highmark BCBS, unless Golden Rule has surprised me by enrolling a significant number of people off-exchange this year.

Today the Delaware Dept. of Insurance issued this press release:

Highmark Requests 2018 Health Insurance Rate Increase of 33.6%

Date Posted: Wednesday, June 14th, 2017