Arizona

There are only 2 things I'm certain of when it comes to the requested rate hike filings in Arizona's individual market:

  1. It's a confusing mess.
  2. Regardless of #1, Arizona's requested rate hikes are jaw-dropping even when weighted by carrier.

The data below is drawn from two sources: The RateReview.HealthCare.Gov database and Arizona's Health Filing Access Interface (HFAI) SERFF database.

As you can see, there's some confusing and contradictory numbers, but I'll try to muddle through each:

Just 2 days ago I noted that the Arizona state Senate was refusing to vote to reinstate the KidsCare program (aka, Arizona's name for the federal CHIP program) for absolutely no legitimate reason, since the program a) would provide 30,000 low-income children with healthcare coverage which would b) be 100% paid for by the Federal government and would c) bring them in line with every other state in the nation.

Well, it appears that at least some Republicans in Arizona do have at least a bit of decency:

Republican lawmakers maneuver to force a vote on KidsCare, reviving a debate over the role of government in people's lives vs. personal responsibility

Chastened and angry over their failure to reinstate KidsCare, Republican lawmakers in the Arizona House got Democrats to join them Thursday in a successful bid to revive the children’s health-insurance program.

Health plan for needy kids rejected by Arizona lawmakers:

PHOENIX - The Republican-controlled House on Tuesday refused to restore a federally-funded health insurance program for children that's used by every other state in the country.

House Democrats staged a last-ditch fight to revive the KidsCare program with an amendment to the state budget.

Republicans said allowing the amendment would have "blown up" the state budget, even though the program costs the state nothing.

...Just a few months ago, the House had passed a bill restoring KidsCare with strong bipartisan support. But Senate President Andy Biggs wouldn't give the bill a hearing in his chamber.

An estimated 30,000 children of lower-income working parents would have been covered by KidsCare. The program was suspended by the Legislature during the recession. 

The cost of the program is covered by federal dollars at least through 2017 and possibly through 2019. 

"Get him out of my sight, Lou! I want him in town, though. He's still under contract. I want you in town, Fink...and out of my sight." --Barton Fink

The big ACA story Thursday morning was about UnitedHealthcare announcing that while they're still available across half the country for 2016, they may drop out of the ACA exchanges next year (2017). Furthermore, they're cutting their marketing/promotional efforts for the exchanges and, in an additional exclusive tidbit from myself, they've also informed their commission-based brokerage network that they'll be slashing their commission rates by as high as 80% for exchange-based enrollments. On top of that, they've even supposedly deliberately disabled various database tools used specifically by brokers to assist in helping people sign up for UHC policies through the exchanges.

Hat tip to Politico's Paul Demko for the story (subscription only) and Katie Jennings for the tip. According to the Arizona Dept. of Insurance, an 11th CO-OP is being pulled off of the ACA exchange literally hours (as in, less than 24 hours) before the launch of the 2016 Open Enrollment Period:

Meritus Health Placed Under Supervision

Two Arizona health insurance companies have been placed under supervision by the Arizona Director of Insurance, Andy Tobin.  Director Tobin filed an Order for Supervision on October 30, 2015, to place Meritus Health Partners and Meritus Mutual Health Partners into supervision.  Meritus declined to consent to the Order for Supervision.  The Meritus companies’ ability to write new policies or renew existing policies is suspended.  The Centers for Medicare and Medicaid Services has removed the Meritus plans from the Marketplace.  Director Tobin, appointed as Supervisor under Arizona law, will oversee the two companies.

IMPORTANT: See this detailed explanation of how I've come up with the following estimated maximum requested weighted average rate increases for this state.

As explained in the first link above, I've still been able to piece together rough estimates of the maximum possible and most likely requested average rate increase for the state's individual market:

As noted in the table, the Arizona analysis is even more fuzzy than most other states, because the enrollment/market share estimate for Health Net is a guess. According to their Q2 2015 SEC filing (page 49), Health Net had 69,000 people enrolled in individual policies in Arizona as of 6/30/15. They don't break out grandfathered/transitional policies (I'm assuming about 14% combined), nor do they provide a PPO/HMO split, so I'm just going with 50/50, or 60K total ACA-compliant enrollees.

Florida Gov. Rick Scott announced Thursday that his administration will file a lawsuit against the federal government for threatening to withhold more than $1 billion in funding for hospitals if the state fails to expand Medicaid.

“It is appalling that President Obama would cut off federal health care dollars to Florida in an effort to force our state further into Obamacare,” Scott said, citing a 2012 Supreme Court ruling that said the federal government couldn’t put a “gun to the head” of states to force them to expand Medicaid under the health care law.

The Obama administration quickly accused Scott of misconstruing that court decision because the state is not being forced to do anything. And White House spokesman Josh Earnest blasted the governor for putting politics above people.

Lest we forget, the Affordable Care Act's Medicaid expansion provision is still churning along in over half the country...

Arizona may not be adding Medicaid expansion recipients at nearly the same rate as states like Michigan, West Virginia and Arkansas, but they're doing a pretty good job; AZ is now up to over 192K people, or about 41% of the estimated 469K uninsured individuals who are eligible for Medicaid:

During the month of June, 19,736 were added to AHCCCS in the Proposition 204 Restoration Category (0-100% FPL) and 4,771 were added to Adult Expansion category. To date, 192,268 Arizonans have been added since January. The total AHCCCS population now stands at 1,552,186.

 

The QHP number (80K) looks about right, but that 67K Medicaid number bears no connection whatsoever to the existing number (91,115). On the other hand, AZ has some sort of unusual situation going on with their Medicaid program anyway, so I'll leave that one alone for now.

As of March 1, the enrollments were behind projections, with just about 58,000 enrolled. But Plese said she’s seen unofficial figure that show the number rose to about 80,000 by mid-March.

Another 67,000 who used the federal site had been determined to be eligible for Medicaid.

I received the following yesterday, and was given the OK to post it publicly. Given my prior screeds about both a) off-exchange enrollments and b) insurance company billing systems being overwhelmed/backlogged, this is a perfect example of why both of these issues are so important to include when discussing the QHP numbers.

Obviously anecdotal stories can't be used as hard data, but I've read dozens of similar stories. Some refer to going off-exchange; some refer to billing problems with the companies; some, like this one, refer to both. Presented without further comment (emphasis mine):

I'm an independent contractor/consultant in Arizona. I have several friends in the same boat. We all had Arizona state-sponsored (but not supported) small business insurance that had no underwriting.

We were all basically locked out of the ACA website from early on and never got back on. BUT WE ALL BOUGHT insurance with BCBS directly, with ACA policies (none of us could have gotten through underwriting) because we all make too much for a subsidy. NONE of us, and the people like us, are being counted. But I'm sure BCBS is keeping track of these direct purchases, which have to be counted toward the total.

When I first read this article submitted by contributor Maurice H., I was pretty concerned, as it made it sound like Arizona's exchange QHP total was only around perhaps 60,100 as of March 18 (the artilce was posted on the 19th):

Final numbers for Arizona enrollment will not be available for a few weeks, but more than 80,000 Arizonans have enrolled in Medicaid and more than 60,000 have enrolled in private health care plans through the site, said Herb K. Schultz, regional director of the Health and Human Services Department.

This concerned me because Arizona already had 57,611 QHPs as of March 1st...and had 43,495 on February 1st. That means that AZ's February average was 504/day.

If the 3/18 number was only around 60,100, that would mean they were only at 2,489 for March, or only 146/day…a 71% plummet from February.

UPDATE: On the down side, I was off by 4% this time around.

On the up side, I UNDERESTIMATED:

Actual Feb. enrollments: 942,833, for a total of 4,242,325 thru 3/01/14.

Sarah Kliff at Vox just announced that the February HHS report is expected to be released today at around 4:00pm. A few items in anticipation of that:

  • As I've noted several times, I'm projecting the report to total around 902,000 exchange-based private QHP enrollments for the month of February (technically 2/02 - 3/01)
  • If accurate, this would bring the cumulative total of exchange-based private QHP enrollments to 4.202 million (from 10/1/13 - 3/01/14)
  • From the data I have, the average daily enrollment rate in February was almost identical to that of January, which had about 1.146 million QHP enrollments. HOWEVER, the January report included five weeks of data (12/28 - 2/01), while the February report will only include four weeks (2/02 - 3/01). Therefore, even at the same daily average, it'll be about 20% lower no matter what.
  • Don't be surprised if Peter Lee of CoveredCA decides to steal some thunder by announcing that California has enrolled 1,000,000 QHPs all by itself either today or tomorrow. However, that would include the past 10 days, while the HHS number will only run thru 3/01.
  • If you want to get REALLY specific, call it 902,800 and 4,202,292.
  • I've been dead-on target 6 times in a row without hyping up my projections beforehand. This time I am hyping myself up beforehand, so I'll probably be way off...but as long as I've UNDERestimated the tally, I'll be perfectly fine with that...
  • The report will be released in about 5 minutes, but my kid gets home from school in about 10, so it'll be a good 20 minutes before I can really post anything. Feel free to follow Sarah Kliff of Vox in the meantime!

Whoops...looks like I may have misread the previous Cover Arizona report. It had stated the total added to Medicaid due to Prop 204 restoration + Expansion as being 134,674, but they didn't specify the starting date for that figure; this time they're more specific, giving the total as 91,115 since October, which is the relevant date. Correcting now...sorry about the mix-up.

As of March 1st, AHCCCS reported that there had been 85,309 Arizonans added to AHCCCS under the Prop 204 restoration category (adults between 0-100 FLP) and 5,806 added to the expansion category (100 -133 FPL) since October. In total, that adds up to more than 91,000 Arizonans who have been added to AHCCCS since October due to the restoration/expansion.

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