Alaska

There was a time, just a few months ago, when it looked like Alaska, which had already suffered from massive rate hikes the past 2 years due to their unique healthcare situation, might have a complete catastrophe on their hands with a third year of massive individual market rate hikes.

Fortunately (and to their credit), the GOP state legislature worked with the Independent governor to pass a new law which created a state-based reinsurance program to stave off the ugly hikes. In July, it looked as though this would result in not-fantastic-but-not-awful 10% average increase:

A major health insurer is seeking an average rate increase of about 10 percent on individual health insurance policies in Alaska, far less than what it received the last two years. Thisfollows recent steps by the state to shore up Alaska's insurance marketplace.

Premera Blue Cross Blue Shield is expected to be the only company offering individual health policies in Alaska in 2017, with Moda Health planning to leave that market. Premera received average rate increases of nearly 40 percent for 2015 and 2016.

(Originally Posted 6/09/16)

Every year, Republicans insist that the ACA is guaranteed to cause a rate hike "death spiral" as increasing premiums cause healthier people to drop out of the individual exchange market, causing higher medical expenses, causing even higher premiums, causing more healthy people to drop out and so forth...and every year, for three years in a row so far, this has failed to be the case nationally. While premiums have obviously continued to increase for many people, the individual insurance market has grown each year, from around 11 million in 2013 to 15.6 million in 2014, around 17 million last year and up to 19-20 million or so today.

Back in January I noted that Moda Health Plans, which had plenty of self-inflicted wounds in addition to being kneecapped by the Risk Corridor Massacre, was dropping out of the Oregon exchange and likely the Alaska exchange as well, so today's news isn't a big surprise.

Even so, this is definitely a major problem for the Alaska individual market, which was already extremely expensive prior to the ACA and which now only has a single insurance carrier participating (h/t to Louise Norris):

The individual market in Alaska has just two carriers in 2016: Moda and Premera. Both have struggled with significant losses under the ACA, and Moda nearly exited the Alaska market altogether in late January (more details below).

Hey, remember the Risk Corridor Massacre?

Remember how the Risk Corridor program was put in place specifically to help guide insurance carriers through the rocky, turbulent, confusing waters of the early years of the ACA exchanges by mitigating massive premium rate miscalculations the first few by having carriers which did better than expected chip into a kitty to be passed out to those which missed the target for the first 3 years?

Remember how the carriers which lost money the first year were really, really counting on those Risk Corridor funds to be there to help cushion the blow?

Remember how, just over a year ago, Sen. Marco Rubio came up with the brilliant idea of cutting off the Risk Corridor program at it's knees, then cramming that idea into the "must-pass" CRomnibus bill?

Remember how as a result, when it came time to start doling out the RC funds to the carriers which had a crappy first year, there were only 12 cents on the dollar sitting in the cupboard?

Until this year, most of the ACA exchanges, including HealthCare.Gov, would simply report how many people selected QHPs through the exchange, whether paid up or not. There's nothing wrong with this as long as it's made clear at some point how many people actually paid their premiums and had their policies effectuated; the argument over this issue was the entire basis of the infamous "But how many have PAID???" fuss back in 2014. It was such a Big Deal that the Republicans on the House Energy & Commerce Committee even published the results on a laughably garbage-filled "survey" they had sent out to a portion of the insurance carriers.

(Note In the end, it turned out to be roughly 85-90% depending on the state/carrier in 2014; for 2015 the payment rate nudged up to around 90% overall, which is where it will likely stand going forward).

One other small Medicaid expansion entry: Alaska, which just formally launched the expansion program on September 1st, has enrolled about 7,700 residents to date. While that's a pretty tiny number, Alaska only has about 740,000 residents total, of which only 42,000 are even eligible for ACA expansion anyway:

JUNEAU, Alaska (AP) — About 7,700 people have enrolled in Medicaid since the state expanded the program on Sept. 1 to cover more lower-income Alaskans, a state health department official said.

The agency appears on track with projections that a total of about 20,100 newly eligible people would enroll in Medicaid during the first year of expansion, Chris Ashenbrenner, Medicaid program coordinator for the health department, said Tuesday.

A study commissioned by the department estimated that about 42,000 people would be eligible for Medicaid under expansion but only about 20,100 would enroll the first year.

 

Feast your eyes, FOX News, Daily Caller, Breitbart, etc!!

Of course, there are a few caveats, which I'm sure you guys will be certain to include when you report on this:

Twenty-seven Alaskans were approved for benefits under Medicaid expansion Tuesday, the first day of the broadened health care program, the state Department of Health and Social Services announced Wednesday.

According to state officials, about 40,000 people are potentially eligible for the expansion program, although as Xpostfactoid pointed out a month or so ago, the Kaiser Family Foundation has a much lower estimate (more like 11,000).

Either way, the actual number enrolled or in the process is quite a bit higher than just 27...

As noted a few days ago, now that a judge has put the kibosh on a legal hold, Alaska Governor Bill Walker's executive order to expand Medicaid statewide via the ACA expansion provision officially starts today, bringing healthcare coverage to up to 40,000 low-income Alaskans:

Beginning today, low-income uninsured Alaskans can apply for health coverage because of Governor Bill Walker’s decision to expand Medicaid as part of health reform.  This makes Alaska the 29th state (plus the District of Columbia) to implement the expansion (see map).

Across the country, Medicaid expansion has produced state budget savings, and the historic gains in health coverage since health reform took effect have been greatest in expansion states.  Now Alaska is poised to reap immediate and positive benefits of expansion: the state projects expansion will make 40,000 people eligible for coverage and could save the state budget up to $6 million this fiscal year, with greater savings in future years.  

After yesterday's ugly news about Alaska's private policy rate hikes, this is welcome relief:

Judge says Alaska Medicaid expansion can go ahead Tuesday

An Anchorage trial court judge Friday said that Alaska Gov. Bill Walker’s administration can expand the Medicaid health care program starting next week, dismissing a request by the state Legislature to temporarily block enrollment while attorneys fully argue lawmakers’ legal challenge.

In a 45-minute opinion delivered from the bench, Pfiffner rejected a series of arguments by the Legislature that starting expanded Medicaid enrollment Tuesday was so problematic that it should be put on hold while the Legislature’s lawsuit proceeds.

The actual lawsuit will still proceed, but this is still great news for up to 40,000 Alaskans.

Not such great news in Nevada, however:

Nevada Health Co-Op to close, leaving thousands to find new insurance

I know I'm not supposed to repost entire news stories, but this one is literally 6 sentences, so click on some Alaska Dispatch News links to give them some love, willya?

JUNEAU — The state Division of Insurance has approved average rate increases for next year of nearly 40 percent for the two companies providing individual health insurance plans through the federally run online marketplace.

Division director Lori Wing-Heier says Premera Blue Cross Blue Shield and Moda Health cited the high cost of medical services as one of the factors in requesting rate increases.

She also said Alaska has a relatively small market and very small group of individuals with high-cost claims.

She said the average rate increase approved for Premera was 38.7 percent and 39.6 percent for Moda. She said that applies to individual plans on and off the online marketplace.

Wing-Heier says the cost of health care in Alaska has been a long-standing concern, with no clear answers for addressing it.

Well, this is certainly welcome news (and a bit unexpected) (h/t to Robin Simpson):

Alaska Governor Sidesteps GOP-Controlled Legislature, Expands Medicaid On His Own

Alaska will become the 30th state to accept Obamacare’s optional Medicaid expansion, after Gov. Bill Walker (I)announced on Thursday that he will use his executive power to bypass the GOP-controlled legislature and implement the policy on his own.

Walker — a former Republican who has since become an Independent — has been advocating for Medicaid expansion for over a year. Implementing this particular Obamacare provision, which was ruled optional by the Supreme Court in 2012, would extend health coverage to an estimated 40,000 low-income residents in his state. Polling has found that the majority of Alaska residents agree with Walker’s position.

OK, this may seem like a minor thing, but you just know there's that one family in Juneau which waits until the last minute...

Midnight Monday, Pacific time, is the deadline for new customers to pick a health plan that will take effect Jan. 1, and for current enrollees to make changes that could reduce premium increases ahead of the new year.

HealthCare.gov and state insurance websites are preparing for heavy online traffic before the deadline, which gives consumers in the East three hours into Tuesday to enroll.

Thanks to contributor farmbellpsu for the heads' up.

Also, 21 year olds (in all states, not just Alaska) should pay special attention:

Doing nothing appears to be a particularly bad idea for people who turned 21 this year, according to the Center on Budget and Policy Priorities, a Washington group that advocates for low-income people.

Alaska:

On the campaign trail, Bill Walker made expanding the state’s Medicaid program under the Affordable Care Act one of his top priorities. He said he could make the decision without input from the state legislature:

“It’s up to the Governor to accept that.”

But when Walker takes office next month, will it really be so easy to expand a program that has been a tough sell in other conservative states?

Medicaid expansion would allow around 40,000 low income Alaskans– mostly childless adults, to receive health benefits. The federal government will pay 100 percent of the program until the end of 2016. After that, the state’s share will slowly increase to 10 percent by 2020. Walker has said the decision is a no-brainer, at least while the federal government is providing full funding.

Wyoming:

With a plan released Wednesday by the administration of Gov. Matt Mead, a Republican, Wyoming has become the latest state seeking to expand Medicaid.

Deaconblues provides another article with a similarly curious private enrollment update. I just reported that Ohio's 2014 open enrollment tally was apparently several thousand people higher than originally thought. Now it seems that the same is true in Alaska:

When the ACA open enrollment period ended for 2014, approximately 16,000 Alaskans had purchased individual health insurance plans, with nearly 9,000 receiving federal subsidies through the Federally Facilitated Marketplace.

The official HHS report gave Alaska's number as 12,890 as of 4/19...this is 24% higher than that. The first thing which crossed my mind is that the 16K figure might refer to the current gross enrollment figure, which should indeed be about 18% higher than it was in mid-April nationally. However, the fact that the article itself is an extremely anti-ACA screed by the Alaska Commerce Commissioner makes me pretty confident that she wouldn't try to make the actual enrollment numbers any better than they actually were.

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