NOTE: My broadband connection has been experiencing a lot of problems lately; I have a service guy on his way out today for the fourth time in the past two weeks, but this means I'll likely be offline for a few hours, so this post will be incomplete for awhile.
Centers for Medicare and Medicaid Services Releases Reports on the Performance of the Exchanges and Individual Health Insurance Market
Reports show individual market erosion and increasing taxpayer liability
Um...yeah, deliberately sabotaging the ACA a dozen different ways and cutting off CSR reimbursement payments, thus forcing the carriers to load CSR costs directly onto premiums, which in turn jacks up APTC subsidies accordingly, will have the effect of "increasing taxpayer liability"). Go on...
On November 8, 2010--right after the "Red Wave" midterm election in which Republicans picked up a jaw-dropping 63 seats in the U.S. House of Representatives, 6 Senate seats and 680 state legislative seats--Paul Waldman wrote, in The American Prospect:
In charting the last two years, from the euphoria of election night 2008 to the despair of election night 2010, I keep returning to Mario Cuomo's famous dictum that you campaign in poetry but govern in prose. The poetry of campaigning is lofty, gauzy, full of possibility, a world where problems are solved just because we want them to be and opposition melts away before us. The prose of governing is messy and maddening, full of compromises and half-victories that leave a sour taste in one's mouth.
...All else being equal, this means Republicans have an easier time getting elected and a harder time legislating the things they really want to do (other than tax cuts, which are never a hard sell), while Democrats have a harder time getting elected but ought to have an easier time legislating.
For nearly a year, healthcare wonks like myself, David Anderson, Andrew Sprung and Louise Norris have been heavily getting the word out to promote not just the "Silver Loading" CSR-load workaround, but an even more clever variant which I've coined "the Silver Switcharoo" which takes the concept of Silver Loading and goes one step further.
*(OK, these are technically only "semi-approved" rates...there could still be some additional tweaks later on after public comment, etc.)
Oregon was the fourth state which I ran a preliminary 2019 rate increase analysis on back in May. At the time, I concluded that insurance carriers were requesting a weighted average increase of 10.5% for ACA-compliant individual market policies next year. I knew that Oregon's state-based Reinsurance program was helping keep that average down to some degree, but I didn't know exactly how much of a factor it was.
I also knew that efforts to sabotage the ACA by Donald Trump and Congressional Republicans would play a major role in increasing 2019 rates: Repeal of the individual mandate is a big factor, along with the unnecessary 1-point increase in the state exchange fee being imposed on Oregon and the other four states which run their own exchange but "piggyback" on HealthCare.Gov's technology platform.
This article from KTVQ is excellent for my purposes. It clearly and cleanly plugs in just about all of the hard numbers I need to run my rate hike analysis: Which carriers are participating in the 2019 ACA individual market; how many current enrollees each carrier has (both on and off the exchange); and the exact average increase each one is requesting for next year!
Health insurers selling individual policies on the “Obamacare” marketplace in Montana are proposing only modest increases for 2019, on average – or, no increase at all.
State Insurance Commissioner Matt Rosendale released the proposed rates Thursday, with Blue Cross and Blue Shield of Montana proposing an average increase of zero – and a 4.9 percent decline for small-group policies.
The other two companies selling policies on the online marketplace, PacificSource and the Montana Health Co-op, proposed average increases of 6.2 percent and 10.6 percent for individual policies, respectively, and lesser increases for small-group policies.
A couple of days ago, the nonpartisan Kaiser Family Foundation posted an important new analysis (actually a follow-up version of an earlier one they did in May) which proved, in several different ways, that after years of turmoil, the ACA's individual market had finally stabilized as of 2017...or, at least, it would have if not for the deliberate sabotage efforts of one Donald J. Trump and several hundred Congressional Republicans. This included hard numbers for the first quarter of 2018 which showed the trend continuing in a dramatic fashion.
Following up on that, they went further yesterday and posted a whole bunch of handy raw individual market data for the 2011 - 2017 calendar years at the state level, including the average gross profit margin per member per month as well as the share of premiums paid out as claims in every state (except, frustratingly, California).
State’s Market Stability Workgroup Recommends Immediate Action to Protect Rhode Islanders from Federal Threats to Health Insurance Access and Affordability
Posted on June 27, 2018 | By HealthSource RI
EAST PROVIDENCE, R.I. (June 27, 2018) – Rhode Island must act “without delay” to protect consumers from rising health coverage costs brought on by federal policy changes according to a report issued to Governor Raimondo by the state’s Market Stability Workgroup.
“People representing a wide variety of viewpoints engaged in lively discussions over the course of 8 weeks,” said Workgroup co-chair Bill Wray, Chief Risk Officer at the Washington Trust. “The fruits of those discussions are in this report. All of us – consumer advocates, business groups, health insurers and providers – were able to broadly agree on how best to protect Rhode Island’s insurance markets.”
*(technically Vermont was the third to do so, but theirs doesn't kick into effect until 2020, and they haven't even crystalized exactly what form it would take anyway.)
**(yeah, I know very well that DC isn't actually a state, but it's pretty awkward to put "state and/or territory" in the headline.)
I realize that 110% of the news/media/political attention is on the bombshell announcement that Supreme Court Justice Anthony Kennedy is retiring at the end of July, but there are other things going on as well, so I'll do my best to soldier on...
More big health care action at the state level: yesterday the DC Council passed what would be the nation's third state-level individual mandate, after Mass. and NJ.https://t.co/BmtnDAQvVp
The Kaiser Family Foundation runs a monthly, national tracking poll which is considered one of the Gold Standards when it comes to healthcare policy surveys. Here's the methodology for their June survey:
This Kaiser Health Tracking Poll was designed and analyzed by public opinion researchers at the Kaiser Family Foundation (KFF). The survey was conducted June 11th–20th 2018, among a nationally representative random digit dial telephone sample of 1,492 adults ages 18 and older, living in the United States, including Alaska and Hawaii (note: persons without a telephone could not be included in the random selection process). Computer-assisted telephone interviews conducted by landline (319) and cell phone (1,173, including 793 who had no landline telephone) were carried out in English and Spanish by SSRS of Glen Mills, PA.
For weeks now, I've been painstakingly analyzing and plugging in the preliminary 2019 rate change data for ACA-compliant individual market as each state submits their filings. As of today, I've compiled data for 18 states (+DC), comprising perhaps 40% of the total ACA individual market, give or take. The table below shows where things stand at the moment.
Those yellow and manilla cells at the bottom are not a typo: To the best of my estimates so far, the insurance carriers across these 19 markets are asking for average 2019 unsubsidized premium rate increases of around 10-11%...however, as far as I can tell, they would be keeping rates FLAT year over year (on average), for the first time since the ACA launched, if not for three sabotage efforts by Donald Trump and Congressional Republicans: Repeal of the ACA's individual mandate, and Trump's removal of restrictions on non-ACA compliant "Short-Term, Limited Duration" and "Association" plans, which I've shorthanded as simply #ShortAssPlans....and in fact would actually be dropping in quite a few states (or, in the case of Minnesota, dropping more than they already are set to with those factors):
Yeah, that's right...I turn 48 today. I've never been shy about self-promotion, and I am still trying to turn my "healthcare data/policy analysis & snark" thing into a full-time career, so I thought about the best way to approach it.