2018 MIDTERM ELECTION

Time: D H M S

Several weeks ago I wrote about a bit of a bombshell development in Virginia:

Members of local advocacy group Charlottesville For Reasonable Health Insurance had provided testimony at the Virginia General Assembly and organized an email campaign, helping to ensure passage of the bill through the legislative session. Introduced by Sen. Creigh Deeds and effective July 1 2018, SB672 will allow self-employed people to take advantage of the much more affordable health plans in the small group business marketplace, without having to hire employees.

...Charlottesville and surrounding counties (Albemarle, Green, Fluvanna) have by far the most expensive healthcare premiums in the nation in 2018. Rates more than tripled for consumers buying coverage on the ACA Individual Exchange, making comprehensive insurance unaffordable for people who do not qualify for subsidy assistance. A typical family of four is being charged $3000 per month for high deductible plans.

via Alice Ollstein of Talking Points Memo:

A state court in Maine has ruled that Gov. Paul LePage (R) must submit the paperwork necessary to move forward on expanding Medicaid under the Affordable Care Act to cover about 70,000 more low-income people in the state.

In her ruling, state judge Michaela Murphy slammed LePage’s health department for unilaterally blocking the expansion’s implementation since voters overwhelmingly approved it by ballot initiative last November.

“The Court concludes that the Commissioner’s complete failure to act cannot be considered substantial compliance,” she wrote, ordering the governor to submit the necessary paperwork to the federal government by June 11.

It wasn’t immediately known whether LePage planned to appeal the decision.

PREDICTION: Yeah, he will. He's out of office in seven months, and I'm willing to bet he's gonna continue doing everything possible to drag this out until his replacement takes office in January.

Hot on the heels of Washington State releasing their preliminary 2019 individual market rate hike request comes a similar press release out of the New York Department of Financial Services...and neither the carriers nor the state regulators are making any bones about the reason for next year's rate increases:

PROPOSED 2019 HEALTH INSURANCE PREMIUM RATES FOR INDIVIDUAL AND SMALL GROUP MARKETS

Health insurers in New York have submitted their requested rates for 2019, as set forth in the charts below.  These are the rates proposed by health insurers, and have not been approved by DFS.

The good news? As I reported a week or so ago, every county in Washington State will have at least one carrier on the ACA exchange next year.

The bad news? As expected, thanks in large part to sabotage of the ACA by Donald Trump and Congressional Republicans, the average requested 2019 premium increase for unsubsidized enrollees is 19.1%:

OLYMPIA, Wash. – Eleven health insurers filed 74 health plans for Washington state’s 2019 individual and family health insurance market, with an average proposed rate increase of 19.08 percent. There are no bare counties, although 14 counties will have only one insurer selling through Washington’s Exchange, Washington Healthplanfinder. 

Several quick tidbits out of the District of Columbia from the DC Health Benefit Exchange Authority May board meeting:

  • Their preliminary 2019 premium rate filings were originally due by May 1st, but this was bumped out until June 1st. Not available publicly yet, however.

As I noted last week, insurance carriers in North Carolina were supposed to have submitted their preliminary 2019 premium rate change filings as of May 21st. Unfortunately, as I also noted last week, those "deadlines" appear to be more "guidelines" in many states, with North Carolina among them; there's no publicly-available premium change data available yet.

However, as Louise Norris notes over at healthinsurance.org, there's some interesting news afoot in the Tar Heel State:

Looking ahead to 2019

Insurers that wish to offer individual market coverage in North Carolina in 2019 had to file rates and forms by May 21, 2018. The two insurers that offer 2018 coverage in the North Carolina exchange — Cigna and Blue Cross Blue Shield of North Carolina — have both filed rate for 2019. Although the filings do show up in SERFF, they have very little publically available data at this point.

PLEASE NOTE IMPORTANT UPDATES BELOW.

I just received the following from a healthcare broker, who I trust from past communication exchanges, who wishes to remain anonymous. I'm presenting it as sent, with the only changes being breaking it out into paragraphs for readability & with their state's identifying information removed.

Glossery:

Over the past few weeks I've noted that a half-dozen states or so (Maryland, New Jersey, Vermont, Hawaii, California and Illinois) have been pushing through a long list of bills/laws at the state level to either protect the ACA from sabotage or even strengthen it. Meanwhile, other states have either expanded Medicaid under the ACA (Virginia, of course) or have locked in ballot measures to do so this fall (Utah, Idaho). Finally, several states have announced they're joining dozens of others to take advantage of "Silver Loading" or full-on "Silver Switching".

Well, things haven't slowed down. Just a few days after eight different ACA/healthcare bills passed out of either the state Senate or Assembly, California legislators have passed several more:

Rhode Island is the 5th state (to my knowledge) to officially post their preliminary 2019 individual market rate change requests.

As shown below, things are pretty cut & dry in Rhode Island; they only have 2 carriers participating in the individual market (Blue Cross Blue Shield and Neighborhood Health Plan). BCBSRI is asking for a 10.7% average increase, while Neighborhood is requesting 8.7% overall.

The estimated market share ratios are based on this press release from HealthSourceRI, the state ACA exchange. That doesn't include the final numbers or the off-exchange enrollment, but it should be pretty close, as there are only 2 carriers and their requested increases are so close to begin with it wouldn't make much difference. The weighted average is 9.3%.

Last night I made a big fuss about New Jersey Governor Phil Murphy signing a restoration of the ACA's individual mandate penalty into law.

It turns out that the Governor of Vermont also signed the ACA mandate restoration bill I wrote about back in March into law a few days ago as well...but it's not as noteworthy, for several reasons. As Louise Norris reports over at healthinsurance.org:

Vermont governor signs legislation to implement an individual mandate starting in 2020; working group will sort out enforcement details

Last week I noted that the New Jersey state legislature, along with new Governor Phil Murphy, has moved quickly to pass and sign into law a number of critical ACA protection bills, to:

  • Reinstate the ACA's individual mandate penalty,
  • Establish a robust reinsurance program to significantly lower insurance premiums for individual market enrollees,
  • Protect people from out-of-network "balance billing", and
  • Cancel out Trump's expansion of "Association Health Plans"

In addition, New Jersey already outlawed "Short-Term Plans" (and "Surprise Billing") before the ACA was passed anyway.

Well, until today, there was some lingering doubt about the first two bills (which are connected...the reinsurance program would be partly funded by the revenue from the state-level mandate penalty), as Gov. Murphy was reportedly kind of iffy about signing them. As I understand it, he's been supportive of both ideas but is concerned about the potential budget hit in case the mandate penalty revenue doesn't raise enough to cover its share of the reinsurance program.

Apparently it still has to be kicked back to the state Assembly for a final vote, but it appears to be a done deal at last:

The Virginia Senate just passed Medicaid expansion, which three Republicans joining all 19 Democrats voting in favor. The House, which already passed expansion, has to vote again. We'll have more later, but here's the backstory. https://t.co/ldFEb5vYyt

— Jeffrey Young (@JeffYoung) May 30, 2018

There's one downer, of course:

Elections have consequences: To get enough GOP votes, this Medicaid expansion includes a work requirement and premiums above the poverty line, which will cut into coverage gains. Virginia must continue the fight.

— Topher Spiro (@TopherSpiro) May 30, 2018

*(OK, it's possible that "no one" actually means "everyone except for me.")

Last summer, both houses of the Nevada state legislature quickly and surprisingly passed a full-blown Medicaid Public Option bill:

I wrote about this back in April, but even I didn't think much of it at the time--I assumed it was more of a symbolic proposal than anything, or that it would die in committee at most. The details are important, of course, but assuming they make sense, this is exactly the sort of approach I would recommend in trying to gradually transition to some type of universal single-payer like system. The biggest questions I'd want answered are 1) What type of coverage does Medicaid actually have in Nevada? It varies widely from state to state, so if NV's is pretty comprehensive, awesome, but if it's skimpy, that's not very helpful; 2) What sort of premiums/deductibles/co-pays would buy-in enrollees be looking at?; 3) What sort of impact would this have on the state budget?; and most significantly, 4) How many Nevada doctors/hospitals would accept these enrollees? Remember, the reason a significant chunk of healthcare providers don't accept Medicaid patients is because it only reimburses them around 50¢ on the dollar compared to private insurance.

*(OK, 95%+, anyway)

It isn't often that virtually everyone across the entire healthcare field agrees on anything, and yet here we are. Via Noam Levey of the L.A. Times:

Trump's new insurance rules are panned by nearly every healthcare group that submitted formal comments

More than 95% of healthcare groups that have commented on President Trump’s effort to weaken Obama-era health insurance rules criticized or outright opposed the proposals, according to a Times review of thousands of official comment letters filed with federal agencies.

The extraordinary one-sided outpouring came from more than 300 patient and consumer advocates, physician and nurse organizations and trade groups representing hospitals, clinics and health insurers across the country, the review found.

This post actually has almost nothing whatsoever to do with the Affordable Care Act itself.

Every year I dig through hundreds (thousands?) of insurance premium rate filings for carriers in every state. For the most part I ignore everything except for my core focus area, the Individual Market, although on occasion I also try to run analysis of the Small Group market filings as well. I don't really pay much attention to the Large Group market filings.

However, there's a bunch of other types of health/medical insurance as well, and one which I've written next to nothing about since I started the ACA Signups project is also one which is becoming increasingly important as the Baby Boomer generation retires: Long-Term Care insurance.

To illustrate my point, here are a few recent premium rate increase filings from carriers in Connecticut:

Long-Term Care Rate Filing - Connecticut Life & Health Guaranty Association (Individual)

Rate request: 69 percent increase
Decision: Approved January 9, 2018

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