As I noted when I crunched the numbers for Texas, it's actually easier to figure out how many people would lose coverage if the ACA is repealed in non-expansion states because you can't rip away healthcare coverage from someone who you never provided it to in the first place.
For 2017, only Blue Cross Blue Shield of Alabama will participate in the exchange. In August 2016, the carrier filed rate increases for 2017 that average 36.1 percent (with a range from 20.6 percent to 38.3 percent). This was a revised rate filing, and was slightly lower than the average rate increase proposal of 39.3 percent that the carrier initially filed in June.
The Alabama Department of Insurance approved the 36.1 percent average rate increase in October 2016, and the new rates will take effect in January 2017. AL.com reports that pre-subsidy rates for Bronze plans will increase between 20 percent and 23 percent, while Silver and Gold plans will increase in price between 32 percent and 38 percent.
Lots of stuff happening fast & furious these days as #OE4 approaches. Instead of individual posts, I'm gonna cram 7 state updates into a single one...and am also cheating a bit by cribbing off of excellent work by Louise Norris over at healthinsurance.org (which is fair, since she also gets some of her data from me as well):
ALABAMA: Here's what my requested rate hike table looked like for Alabama on August 1st:
As I noted Monday, I believe August 1st was the deadline for every state to submit their 2017 rate filings, meaning that the 14 states missing from my Requested Rate Hike Project are finally available to be plugged into the spreadsheet. I'll also be going back through the other states I've been tracking since as early as April to see which ones require updates due to carriers dropping out, joining in or resubmitting their rate requests.
Health insurance companies that want to raise rates more than 10 percent next year will get an extra dose of scrutiny from Alabama regulators this year – for the first time since the marketplace launched in 2013.
Under Obamacare, states were supposed to implement systems for reviewing, and in some cases rejecting, rate increases that exceed 10 percent. Alabama was one of six states that didn't create an effective rate review program, despite receiving a $1 million grant to bolster oversight at the Department of Insurance, according to the Centers for Medicare & Medicaid Services.
When UnitedHealthcare announced last month that they were making good on their threat last fall to pull out of the individual market in over two dozen states next year, it caused shockwaves across the health insurance industry. It is an important development, as around 800,000 people will be impacted.
This is really just a summary of my last 4 posts. I've combed through the SERFF databases for every state which uses the system for rate filings, and while very few have the actual 2017 rate filing requests listed yet, at least 4 of them have official individual market exit letters submitted for 2017 from Jane Rouse, the Product Compliance Process Owner for Humana Insurance Co:
This list may grow as additional state filing data and/or press releases come out from Humana, but assuming these are the only 4 states Humana is bailing on, the news isn't quite as bad as it appears at first.
To be clear, I'm not saying this is a good development; when you combine it with the recent UnitedHealthcare Dropout Odometer it's more of a drip-drip-drip sort of thing. But it isn't disasterous for the exchanges either (at least not yet).
UPDATE: I've been informed by a reliable source that Humana is also dropping out of the individual market in Nevada next year, although I don't have any actual enrollment data there. Humana is not currently participating on the Nevada exchange, however, so any dropped enrollments would be OFF-exchange only. In fact, I'm pretty sure that the only individual market enrollees Humana has in Nevada are grandfathered policies anyway, so the numbers should be pretty nominal there.
Alabama's Republican governor says he is considering expanding Medicaid under ObamaCare in his state.
"We are looking at that,” Gov. Robert Bentley said Thursday, according to The Associated Press. “We have not made a final decision on that yet, exactly how that would work.”
Bentley indicated that expanding Medicaid, the government health insurance program for the poor, could help get more doctors into rural parts of the state.
"I am concerned about the plight of the working poor,” he said. “If doctors are not paid for seeing those patients, doctors will not go to rural Alabama, because you can't expect a doctor to go to rural Alabama and lose money.”
As with many other states, I'm working with limited enrollment and rate change data here, so plenty of caveats abound. However, Alabama's 2014 individual market was only around 206,000 people, and the ACA-compliant market should be roughly the same this year. I can account for 176,000 of that, so the remaining 30K or so are unknown other than being split among a half-dozen companies which requested rate changes of below 10% increases.
Assuming around 7% on average for the balance, Alabama residents are likely looking at roughly a 24.4% rate hike...assuming they stick with their current plans.
In other words: Shop around, shop around, shop around!
Two of the most heavily Republican states, Utah and Wyoming, appear to be moving closer to an expansion of Medicaid under the Affordable Care Act. Other GOP-dominated states, like Indiana and Tennessee, are also looking more closely at it, despite the hostility of their party’s leaders toward Obamacare.
...Gov. Matt Mead of Wyoming, where Republicans hold 78 of 90 seats in the legislature, acknowledged his opposition to Obamacare but said the statehad to be realistic by embracing Medicaid expansion in one form or another. “I don’t think we can say to those people in Wyoming who are working [and] who cannot get insurance that we’re not going to do anything,” he said.
...While the odds for expansion in Wyoming remain uncertain, Utah seems likely to move in the coming months. There, Gov. Gary Herbert made the case on moral grounds — as a duty to help people he described as “our neighbors, our friends and our family members.”
This one is a bit squirrelly to suss out, and I'm not sure that I've done so correctly, so bear with me. According to the (very short) article:
MONTGOMERY, Ala. (AP) — State officials say Alabama Medicaid's monthly enrollment has topped 1 million for the first time.
Officials said Thursday that a review of data for the first five months of the year show the milestone happened in February. Officials attribute the increase to a federally required transfer of children from the state's All Kids program and changes in how Medicaid eligibility is determined. Officials say the numbers also reflect the first enrollment of individuals who applied for coverage through the federal health exchange under the federal Affordable Care Act.
Enrollment has remained above 1 million in March, April and May.
OK, this doesn't give a complete picture of Alabama's exchange QHP payment rate for two reasons: First, because the 82% figure is a blend of 85K via the exchange and another 20K off-exchange enrollees; second, because while BCBS does have the lion's share (87%) of exchange QHP enrollees in the state, there's still another 12,870 QHPs (out of the 97,870 total in Alabama) which belong to other insurance companies, which may have a higher or lower payment rate to date.
Having said that, assuming that the ratios are representative on both counts, it looks like about 82% of Alabama's enrollees have paid so far:
Some 82 percent of those enrolling in Blue Cross and Blue Shield of Alabama through the exchanges have paid their first month's premium, mirroring figures released today by other large insurers in preparation for congressional testimony.
"We have enrolled over 105,000 members both on and off the federally facilitated exchange in Alabama," said Koko Mackin, BCBS of Alabama said in an email to Al.com. "Over 85,000 members enrolled through the federal exchange, while another 20,000 signed up directly with Blue Cross -- 82% of our exchange enrollees have paid their first month’s premium."
Short and sweet...Alabama was at 55,034 as of 3/01, so this appears to be a spike of nearly 22,000 QHPs. It's technically feasible that the 77K figure includes the 18K Medicaid enrollees which Alabama (a non-expansion state) has added, but I doubt it; that would only leave 4K QHPs in March, and they had over 11K in February, so I think I'm safe here:
So far 77,000 Alabamians have signed up for health insurance through the marketplace.
OK, as noted a little earlier, I underestimated the February HHS Report for Exchange-based Private QHP enrollment by about 4.2%:
My Projection: 902,800 (4.202 million total)
Actual Enrollments: 942,833 (4.242 million total)
I'm perfectly happy to have underestimated. As for where the extra 40,000 enrollments came from, my initial guess would be that California, in particular, started ramping up their big March blitz a bit earlier and more successfully than I figured, which, again, I'm absolutely fine with.Update: Nope, actually, California's numbers plummetted in the 2nd half of Feb due to that ugly technical outage; see below for details.
I'm busily plugging the new enrollment numbers into the spreadsheet even as I type this, and will be updating with various notes and observations, so keep checking in.
OK, I've entered the QHP data; a couple of things to note: