The Missouri Insurance Dept. has released preliminary 2019 rate filings for the individual and small group markets. Interestingly, in addition to the ACA compliant rate changes, they also posted transitional policy rate changes as well, which is unusual.
Missouri's situation is pretty straightforward: Three existing ACA market carriers are sticking around, and a fourth one is jumping in (Medica). Since Medica is new to the market, they don't have any actual rate changes to speak of. The other three are requesting rate increases of 3.7%, 7.3% and -8.6% respectively; Celtic is dropping rates next year.
There are only two insurance carriers participating in the North Carolina individual market this year: Blue Cross Blue Shield and Cigna. That's expected to change for 2019, as Centene (aka Ambetter) is expected to jump into the NC market, but in terms of premium changes, it's just BCBS and Cigna which can be counted in my 2019 Rate Hike project.
Gov. Cuomo just announced that he has directed Supt. Vullo to reject any individual market rate increase that included an increase to compensate for the repeal of the individual mandate
...Assuming that nothing else changes during the rate review process, this makes carriers that didn't associate a % of their rate request with the loss of the mandate big winners...and those who did, not so much.
Sure enough, after watching the half-hour speech by Cuomo, it sure as hell sounded like he was doing exactly that: Instructing the state insurance commissioner to only allow 2019 ACA individual market premiums to increase by around the 12.1% (on average) that they were expecting to go up with the ACA's individual mandate penalty in place instead of the roughly 24% (on average) that they said they'd have to raise them to cancel out the adverse selection impact of the mandate being repealed:
Hot on the heels of Wisconsin's ACA reinsurance program being approved by CMS comes another reinsurance waiver approval, this time for Maine:
The U.S Department of Health and Human Services and the U.S. Department of the Treasury (the Departments) approved Maine’s application for a State Innovation Waiver under section 1332 of the Patient Protection and Affordable Care Act (PPACA) (the waiver). Maine’s application seeks to reinstate a reinsurance program called the Maine Guaranteed Access Reinsurance Association (MGARA) from 2019 through 2023. As a result of the waiver approval, more consumers in Maine may have coverage, consumers will see lower premiums, and the state will receive Federal funds to cover a substantial portion of state costs for MGARA.
Maine’s State Innovation Waiver under section 1332 of the PPACA is approved subject to the state accepting the specific terms and conditions (STCs). This approval is effective for January 1, 2019 through December 31, 2023.
Summary of Maine’s State Innovation Waiver under section 1332 of the PPACA Application
Assuming that nothing else changes during the rate review process, this makes carriers that didn't associate a % of their rate request with the loss of the mandate big winners...and those who did, not so much.
It looks to me like after his short-lived 2016 Presidential campaign (seriously, it only lasted 70 days...heck, even Lincoln Chafee's campaign lasted twice as long), Wisconsin Governor Scott Walker decided to go back to shoring up his image in his home state...and since Wisconsin is one of 14 states which doesn't have any term limits for the top spot, it looks like he's scrambling to move back to the center policy-wise just in time to run for a third term this November:
Scott Walker proposes plan to prop up Obamacare marketplace
After years of fighting Obamacare, Gov. Scott Walker is now seeking to stabilize the state marketplace under the law.
New Jersey was one of a handful of states with a newly-full blue government which took swift and decisive action to cancel out some of the worst ACA sabotage efforts of the Trump Administration and Congressional Republicans this year. The following bills were passed by the state legislature and signed by new Governor Phil Murphy:
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.
In the nearly five years I've been operating this website, I've made it clear that while I'm not a fan of the private, for-profit health insurance industry, I have tried to put myself in their shoes when it comes to business decisions about whether or not to participate in the ACA exchange market and so forth.
For instance, when Blue Cross Blue Shield of Tennessee baked a 7.1% premium hike into their projected 2019 premiums to cover themselves in case the #RiskAdjustmentFreeze turned into a years-long saga a few weeks ago, I noted that it was completely understandable, given the history of CMS reneging on contractual promises over the past few years (first with the Risk Corridor Massacre, then with Cost Sharing Reduction reimbursement payments). In other words, you may think health insurance companies are Evil Greedy Monsters, but a contract's a contract.
Regular readers may have noticed that while I've written plenty about non-ACA compliant Short-Term, Limited Duration (STLD) healthcare policies (the "Short" part of my #ShortAssPlans hashtag), I've written far less about the "Ass" part...namely, Association Health Plans (AHPs)
The main reason for this is that I simply don't undertand AHPs as well and don't want to misinform people about them. The other reason is that they sort of have one foot each in the worlds of the Individual and Small Group markets, and I write mostly about the Individual market.
The report that follows estimates the premium and coverage impact of the DOL proposed rule over a 5-year period (2018-2022). If the rule is finalized as proposed, we estimate the following impacts on the individual and small-group markets:
Last year I estimated that the combined effect of various Republican efforts to sabotage the ACA caused average unsubsidized monthly premiums to increase by an additional $80/month on average nationally, or around $960 more for the full year per enrollee than they otherwise would have had to pay this year. The exact amount varied widely by state, region, metal level and actual policy, of course.
The 2017 sabotage efforts mainly included the cut-off of Cost Sharing Reduction (CSR) reimbursement payments, but also included a mish-mash of other efforts such as the Open Enrollment Period being cut in half, HealthCare.Gov's marketing budget being cut by 90%, HC.gov's outreach/navigator budget being cut 40%, confusion about whether or not the Individual Mandate would be enforced and, of course, the general confusion about whether or not the ACA itself would be repealed given the half-dozen efforts by Congressional Republicans to do so throughout the year.