ACA Sabotage

Alabama

Last year Alabama had only a single insurance carrier, Blue Cross Blue Shield, offering individual market policies anywhere in the state. For 2018, a new carrier, Bright Health Insurance, jumped into the AL market. For 2019, both companies are lowering rates--BCBSAL is only dropping theirs slightly, but Bright clearly way overshot the mark out of the gate and is lowering their prices by 15.5% overall next year.

Unfortunately, neither of the filings clarifies just how many enrollees either has, so I don't know what the relative market share is; I'm going to assume that BCBS held onto about 90% of the total given their monopoly hold last year and the fact that Bright is a new/unknown player in the market (not to mention the fact that Bright seems to have overpriced their first year). Obviously I'll have to change this if I receive hard numbers to the contrary.

It took me four full months for me to analyse the 2019 ACA rate filings for the first 30 states, but the remaining 20 should come fast & furious starting today, because it looks like they were all finally uploaded to the official RateReview.HealthCare.Gov website earlier this afternoon.

Case in point: Hawaii. There's four carrier listings at RR.HC.gov, but this is misleading; two of them are basically double-listed (Hawaii Medical Service Association separated out their PPOs and HMOs into separate listings, but the filing itself merges both; the same is true of Kaiser Foundation Health Plan, whish has On and Off-Exchange policies listed separately in the database but again merges them into the same filing). In reality, Hawaii only has two carriers on the Individual Market as they have for years.

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.

Sabrina Corlette gave the heads up last night...

.@HHSGov hosting media call on short-term plans at 6:30pm ET tonight, suggesting rule release is imminent. For bckground on what's proposed, see #GtownCHIR summary. https://t.co/qFzkLXayYc

— Sabrina Corlette (@SabrinaCorlette) July 31, 2018

And sure enough, they dropped the new rule this morning:

The Trump administration issued new insurance rules Wednesday morning to encourage more Americans to buy inexpensive, skimpy health plans originally designed for short-term use.

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.

Cigna hasn't released their 2019 filings publicly yet, but they only held around a 4% market share last year (around 21,000 enrollees) so unless they raise or lower rates by a huge amount, it's unlikely to move the needle much one way or the other.

The other 96% of the NC individual market belongs to Blue Cross...and they just issued a very public statement about their intentions for 2019:

BLUE CROSS NC FILES TO LOWER ACA RATES BY AVERAGE OF 4.1 PERCENT
31 Jul 2018

 

Monday afternoon there was a hell of a jaw-dropper out of the Empire State:

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

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

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.

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