2018 MIDTERM ELECTION

Time: D H M S

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

Michael Capaldo is an employee benefits consultant and self-described "ACA wonk" out of New York.

I don't know him beyond some in-depth wonky online discussions, but I don't see any reason for him to make the following up:

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

— Michael Capaldo (@consultbenefits) July 30, 2018

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.

— Michael Capaldo (@consultbenefits) July 30, 2018

There's a lot of fuss and bother yesterday about a brand-new report which tries to project what the costs and savings would be if Bernie Sanders' so-called "Medicare for All" proposal were to actually become law.

The biggest gnashing of teeth was over headlines like this one from CBS and this one from Axios screaming about how "IT WOULD COST $33 TRILLION!!!"

...which is, of course, incredibly disingenous and irresponsible on the face of it for several reasons, primarily because that's over a 10 year period.

January 2018:

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.

Even so, it's understandable that the general public usually plays the world's smallest violin for insurers when they see headlines like this:

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.

In fact, the only major entry I've written about Association Health Plans specifically was mostly cribbed from a report by Avalere Health:

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:

A couple of years ago, UnitedHealthcare decided to pull out of the ACA individual market in dozens of states. They stuck around in a handful for 2017, but dropped out of all but two of those this year as well.

Well, next year they're adding one state...but they're making it very clear that they're doing so against their will:

UnitedHealthcare is returning to one of the government-run health exchanges that the nation's largest insurer largely abandoned in 2017.

Minnetonka-based UnitedHealthcare must sell coverage next year on the health exchange for Massachusetts because it now covers more than 5,000 people in the state via small-employer health plans.

The individual and small-group markets are merged in Massachusetts, where state law requires insurers of a certain size to sell on the exchange.

 

Less than three weeks ago, the Centers for Medicare & Medicaid (CMS) dropped a Friday night bombshell: In response to a judicial ruling in a federal lawsuit brought by a small New Mexico insurance carrier, CMS had decided to temporarily "freeze" the transfer of roughly $10.4 billion in Risk Adjustment funds either owed to or owed by several hundred carriers nationwide.

The whole story about how the Risk Adjustment (RA) program, what the lawsuit is about and why the funds were frozen gets pretty wonky, but the bottom line is...

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.

This Just In from the Pennsylvania Insurance Dept...

Insurance Commissioner Highlights Minimal Rate Increases, More Consumer Choice in 2019 Health Insurance Rate Filings

Harrisburg, PA - Insurance Commissioner Jessica Altman today publicly released the 2019 requested rate filings for individual and small group health insurance plans under the Affordable Care Act, highlighting minimal rate increases and increased choices for many Pennsylvania consumers, including a new insurer in the individual market.

“Pennsylvanians want and deserve access to the comprehensive health coverage that the ACA provides. Enrollment over the past few years has remained steady, and this fall enrollees will have more choices, despite the Trump Administration’s relentless efforts to dismantle the ACA,” Gov. Tom Wolf said. “My administration is committed to ensuring that Pennsylvanians remain informed about their growing options and have access to quality, affordable health insurance.”

I noted a few weeks ago that the Oregon Division of Financial Regulation had issued their preliminary rulings on 2019 individual and small group market rate filings. At the time, they had whittled down the average requested indy market rate changes from 10.5% down to 7.8%, while leaving the requested small group rate changes the same (around 5-6% on average).

However, they also made sure to note that there was still one more round of reviews to go through before final, approved 2019 rate changes were locked in. Yesterday the OR DFR came out with those, making only slight further changes on the individual market (they bumped Kaiser up by 0.2 points while lowering Providence by 1.1 points). Providence has twice as many enrollees as Kaiser, so this resulted in an overall, weighted statewide average rate increase of 7.3%.

The final small group market rates were changed a bit more--Providence's increase was cut in half, while UnitedHealthcare's hike was cut by a couple of points.

This just in from the Connecticut Insurance Dept...

The Connecticut Insurance Department is reviewing 14 health insurance rate filings for the 2019 individual and small group markets. The filings were made by 10 health insurers for plans that currently cover about 293,000 people.

Two carriers – Anthem and ConnectiCare Benefits Inc. (CBI) – have filed rates for both individual and small group plans that will be marketed through Access Health CT, the state-sponsored health insurance exchange.

The 2019 proposed rate increases for both the individual and small group market are, on average lower, than last year:

Less than one month ago:

...back in February...the executive board of the DC ACA exchange unanimously voted to reinstate the mandate. It didn't mean all that much at the time, however, because the authority to reinstate it actually belongs to the DC Council.

Well, thanks to Mr. Levitis for the heads up. If you scroll down to Page 138, you can see that the DC Council has indeed done just that:

TITLE V. HEALTH AND HUMAN SERVICES
SUBTITLE A. INDIVIDUAL HEALTH INSURANCE REQUIREMENT

Sec. 5001. Short title.
This subtitle may be cited as the “Health Insurance Requirement Amendment Act of 2018”.

Sec. 5002. Title 47 of the District of Columbia Official Code is amended as follows:
(a) The table of contents is amended by adding a new chapter designation to read as follows:
“51. Individual Taxpayer Health Insurance Responsibility Requirement”.
(b) A new Chapter 51 is added to read as follows:
“CHAPTER 51. INDIVIDUAL TAXPAYER HEALTH INSURANCE RESPONSIBILITY REQUIREMENT.

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