Arkansas

2018 MIDTERM ELECTION

Time: D H M S

So just last Friday I posted the weighted average requested rate hikes for the Arkansas individual market; it came in at 14.9% overall, which is actually one of the lower statewide averages this year. As a reminder, here's what how the breakout looks:

OK, so 3 major carriers asking to jack up rates 15-24%, plus one at 8.5% and two others with just 7 enrollees between them (one of which is, once again, Freedom Life Insurance). So what?

Arkansas was a little weird...while the rate filings for 5 carriers are listed over at RateReview.HealthCare.Gov, the carrier with the largest individual market share in the state, BCBS (aka "USAble Mutual") is nowhere to be seen (there's a sm. group listing for them, but not individual). However, when I went directly to the AR SERFF database, there they were--and it's listed specifically as "2017 Individual QHP Rates", so there's no question here about whether they plan on offering ACA-compliant policies in 2017.

Anyway, between the HC.gov site and the SERFF site I was able to cobble together pretty much all of Arkansas' indy market. The numbers seem about right; AR's indy market was around 303K in 2014; while it's likely up to 375K or so today, the "missing" 70K can easily be attributed to UnitedHealthcare dropping out and/or grandfathered/transitional enrollees.

At 14.9% on average, this is actually good news for 2017, relatively speaking.

Over the past week or so, UnitedHealthcare started making good on their threat last fall to drop out of the ACA exchanges in at least some of the 33 states that they offer individual market policies in. On April 8th they said they were pulling up stakes in Arkansas and Georgia (although they're keeping a small presence in Atlanta via their experimental "Harken Health" division). Then, last Friday, they said they were dropping off the Michigan exchange as well...and just today, Adam Cancryn noted that they're pulling the plug on Oklahoma, while Zachary Tracer says they're pulling out of Louisiana. Ugh.

Thanks to Sabrina Corlette for the heads up:

UnitedHealth Group will stop offering plans on Arkansas' health insurance exchange next year, a spokesman for the Arkansas Insurance Department said Thursday.

The Minnetonka, Minn.-based insurer offered plans this year for the first time, but it didn't submit plans to the department for 2017, department spokesman Ryan James said.

The deadline for insurers to submit such plans was April 1, he said.

This is hardly unexpected news for a couple of reasons. First, UHC made huge waves last November by making a big, dramatic announcement that they might very well drop out of the ACA exchanges altogether next year after taking large losses on exchange enrollees in 2015. As you may recall, this was a very oddly-timed announcement given that they had issued a glowing quarterly report just a month earlier which made it sound like everything was hunky-dory.

This is a huge story which I should have been following, but a) I was on vacation the past couple of weeks, b) I can't cover everything healthcare-related, and c) it's really not directly related to the Affordable Care Act. Fortunately, the Arkansas Times' David Ramsey has been all over it, so I'll let him lay it out for you:

...all three members of the household were among almost 36,000 Arkansans who were kicked off of their health coverage on July 31. Insurance for another 13,000 people across the state will terminate at the end of this month. The cancellations are the result of a statewide sweep of Medicaid performed by the Arkansas Department of Human Services in an attempt to weed out those beneficiaries whose incomes are too high.

Last week I estimated the overall weighted average rate increases for the Arkansas individual market at "between 4-5%", with a rough estimate of around 4.6%.

Today, Arkansas Times reporter David Ramsey has provided the exact market share numbers for Arkansas. When I plug these in, the weighted average comes in a bit higher, at 4.98%:

HOWEVER, according to Ramsey, the Arkansas Insurance Division says that the actual weighted average is only 4.4% overall.

There could be any number of reasons for the discrepancy; it's possible that there's a few additional minor off-exchange carriers who I've missed, or there could be rounding errors/etc. In any event, these are all just estimates anyway, so I'll go with AID's official 4.4% figure.

Yes, I'm back. From what I can tell, the major Obamacare/health insurance-related stories while I was out were a) Scott Walker/Marco Rubio finally releasing their proposed "replacement plans" (such as they are) for the ACA, and b) the approved 2016 rate changes for ACA-compliant individual/small group policies across a whole mess of states (technically all 50 states +DC had to be finalized as of 2 days ago, but it'll still take awhile to dig up all of them, since many news stories & reports may leave out off-exchange plans, increases of less than 10% and/or actual market share for weighting purposes).

I'm ignoring the Walker/Rubio story for the moment, mainly because they're both complete jokes, but will write up something about that later. For now, let's dive into the approved 2016 rate change story, starting with Arkansas.

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 lowmid-range and maximum possible requested average rate increase for the Arkansas individual market. Note: While the table & methodology for Arkansas are the same as most of the other states I've posted on, there's one important difference here; see below for details:

Again, the full explanation is included here.

I was kind of hoping that this morning's Gallup uninsured rate news would include a monthly update for July; instead, it only runs through the end of June, the same quarterly survey results that they released a month ago. Then again, things probably didn't change much in July.

Instead, this time they've broken the numbers out by state:

WASHINGTON, D.C. -- Arkansas and Kentucky continue to have the sharpest reductions in their uninsured rates since the healthcare law took effect at the beginning of 2014. Oregon, Rhode Island and Washington join them as states that have at least a 10-percentage-point reduction in uninsured rates.

THIS JUST IN...

CMS today conditionally approved Delaware and Pennsylvania to operate State-based Marketplaces (SBMs)" #kingvburwell @charles_gaba

— Dan Mangan (@_DanMangan) June 15, 2015

Obama administration has approved Pennsylvania and Delaware’s blueprints to become state-based ACA exchanges next year.

— Dylan Scott (@dylanlscott) June 15, 2015

Hmmm...the headline looks bad, but when you read further it's clearly a matter of perspective more than anything else:

Maryland's health insurance exchange improperly billed the federal government $28.4 million, a Department of Health and Human Services audit reported Friday.

An inspector general's probe found a lack of oversight and internal controls, not criminal wrongdoing, was the cause of the exchange's problems since the marketplace opened in 2013.

Two late-breaking news items, one negative, the other potentially positive:

Arkansas: The good news a few weeks ago was that newly-elected Republican Governor Asa Hutchinson did not kill off AR's unique "private option" Medicaid expansion program as many had feared; instead, he actually proposed extending it pretty much as is for another 2 years, to the relief of decent folks, and the state legislature seemed to be OK with that (another surprise).

The bad news today is that, while the program looks safe for 2 more years...the same legislation kills the program after the 2 years are up:

LITTLE ROCK, Ark. (Reuters) - Governor Asa Hutchinson of Arkansas has signed legislation that will end by 2017 the state’s innovative but controversial adaptation of the Affordable Care Act, which has provided nearly 190,000 residents with health coverage.

David Ramsey has the full skinny on the unpleasant situation in Arkansas, where their "private option" Medicaid expansion program, which was always weird with a beard to begin with, is very much at risk of collapsing altogether:

Well, here we go again. The legislature is once again ready to debate the private option – the state’s unique version of Medicaid expansion, which uses funds available via the Affordable Care Act to purchase private health insurance for low-income Arkansans. Gov. Asa Hutchinson will take a long-awaited position on the policy in a speech at UAMS tomorrow morning. Then it will be up to the legislature. Health insurance for more than 200,000 Arkansans is at stake. Here are some keys to remember as the debate unfolds tomorrow and in the coming weeks. 

The short version: The AR program has to be re-approved by the legislature every year, and requires a 75% majority to do so, so it's a wonder that it's survived this long, frankly.

Talking Point Memo reports:

The Associated Press reported Sunday that newly elected Republican. Gov. Asa Hutchinson is expected to address the program, which uses Medicaid dollars to pay for private coverage, in a speech this week. Arkansas's plan must be re-approved every year.

The program is contending with Hutchinson and a batch of newly elected Republican lawmakers who ran against it. The funding must be approved by three-fourths of the state legislature every year. As TPM previously reported, getting approval in 2014 required a significant amount of horse-trading and deal-making under Democratic Gov. Mike Beebe.

...Even if Hutchinson agrees to keep the so-called private option, he is expected to propose more conservative-minded changes. Senate President Jonathan Dismang told the AP that Medicaid expansion "is not going to exist in its current form."

How many people are we talking about here? Oh, just 218,000 or so.

The good news: Enrollment in the ACA private Medicaid option program is up to 218K, about 7,000 higher than it was as of mid-October.The bad news: With the state legislature & governor's office being completely overrun by Republicans, the future of the program isn't looking great:

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