2018 MIDTERM ELECTION

Time: D H M S

California

Here's yesterday's press release from Covered California referred to by Dan Mangan of CNBC a little while ago:

New Analysis Shows Potentially Significant Health Care Premium Increases and Drops in Coverage If Federal Policies Change

  • California’s premiums could rise by 28 to 49 percent in 2018, and up to 340,000 consumers could lose individual market coverage if changes are made to existing federal policies.
  • The potential rate increase would mean billions of dollars in additional federal spending. The 1.2 million consumers who do not receive subsidies would bear the entire brunt of these increases.
  • The potential decrease of 340,000 insured consumers would not only represent many individuals losing access to potentially life-saving care, but it would result in a sicker risk mix in the individual market and higher premiums for everyone.

SACRAMENTO, Calif. — A new analysis shows the dramatic consequences facing Californians if federal policies are changed from the current structure and there is no longer direct federal funding of cost-sharing reduction (CSR) reimbursements and the individual shared responsibility payment is not enforced when a consumer chooses not to purchase coverage.

The analysis found that Covered California health plan premiums could rise up to 49 percent if two key elements that have been in place for the past four years are changed: Cost-sharing reduction reimbursements are no longer directly funded as reimbursements to carriers, and the shared individual responsibility payment is not enforced.

 

I noted a week or so ago that according to David Anderson of Balloon Juice, rumor has it that many insurance carriers are making their actuaries work overtime to put together multiple rate filings for 2018 based on several different outlooks:

  • Trump/Price/GOP quit screwing around, officially fund CSR reimbursements, enforce the mandate penalty and generally implement the ACA in good faith.
  • Trump/Price/GOP cut off CSR funding but otherwise enforce the law somewhat reasonably
  • Trump/Price/GOP cut off CSR, don't enforce the mandate, keep mucking around with half-assed repeal/replacement bills
  • (etc, etc...several possible scenarios)

Today the California Insurance Commissioner, Dave Jones, made a formal announcement that this is exactly what CA insurance carriers will be allowed to do, and he isn't pussyfooting around with the reasons for the policy change either:

 

Watch the 4-minute clip above and weep.

If you can't hear it, here's the transcript of California Democratic U.S. Senator Diane Feinstein's response when asked how (not if, mind you...how) she would support moving to a Single Payer healthcare system:

She starts out by making an incredibly tone-deaf and inaccurate statement about single payer:

"If by ‘single payer’ you mean that it’s going to be a complete takeover by the government, of healthcare, then I am not there.

IMPORTANT: This is my county-level estimate for California. The congressional district breakout will be following soon.

Update 2/17/17: (SEE BELOW: CONGRESSIONAL DISTRICT BREAKOUT ADDED!!)

Regular readers know that I started out the "How Many Could Lose Coverage..." project at the state level, then moved into analyzing the county-level data, before finally tackling the hardest challenge: Breaking them out by Congressional District.

The state level table includes all 50 states (+DC), while I managed to break out the county level data for 34 states so far before moving into the Congressional District analysis by popular demand. There, I've managed to crunch the numbers for 43 states so far.

OK, I'm a bit confused by Covered California's press release just now:

Covered California Finishes Fourth Open Enrollment With More Than 412,000 New Consumers and Strong Participation From Young Enrollees

  • New plan selections met enrollment projections for the fourth open-enrollment period.
  • Nearly 50,000 consumers signed up for health care coverage in the final two days before the Jan. 31 deadline.
  • Strong finish and overall enrollment are credited to effective work by Certified Insurance Agents and enrollers and robust television, digital, print and outdoor advertising that ran throughout the open-enrollment period.
  • The crucial demographic of young adults ages 18–34 accounted for 37 percent of enrollment, contributing to a healthy risk mix for 2017.

SACRAMENTO, Calif. — Covered California announced Monday that it finished the open-enrollment period with 412,105 new consumers signing up for health coverage.

First Minnesota's ACA exchange, MNsure, announced an 8-Day "don't call it an extension!" Special Enrollment Period mainly targeted at providing a 25% premium discount for those who don't qualify for the normal federal APTC/CSR financial assistance.

Now, Covered California has announced their own 4-day "Overtime" period, although this is more of the standard "waiting in line" variety:

Covered California Gives Consumers More Time to ‘Cross the Finish Line’ as It Prepares for Surge of Enrollment

  • Consumers must begin the application process by the end of Jan. 31 and complete their enrollment by the end of Feb. 4.
  • Thousands of Certified Insurance Agents and Community Enrollment Partners are ready to provide free and confidential in-person assistance.

SACRAMENTO, Calif. — Covered California announced it is giving consumers who attempt to enroll by the Jan. 31 deadline four more days to complete their enrollment.

The last time Covered California released enrollment data, they gave a hard number for new enrollees (258,158) but left the number of people renewing their policies a bit vague ("approximately 1.3 million"). I later learned that the actual number of renewals had been rounded up, so I'm assuming it's actually around 1.27 million; this gives a total of 1.53 million QHP selections as of January 3rd.

Today, CoveredCA issued another update, touting a new enrollee survey which concludes that in California, at least, people don't seem to be shying away from enrolling in spite of the ugly ACA repeal rhetoric coming out of Washington, DC:

Covered California Enrollment Continues at Strong Pace; New Research Suggests ACA News Coverage Is Not Deterring Consumers

Between the big December deadline (for January coverage) having passed and the holiday season, the actual OE4 enrollment data has been pretty sparse the past few weeks. A few minutes ago, however, Covered California broke the enrollment news drought (no pun intended) with a press release which, while not primarily focused on the actual enrollment data, nonetheless includes a solid update:

Covered California Brings Health Care Within Reach and Shows How Consumers Can Save by Shopping

FOR IMMEDIATE RELEASE  •  Dec. 16, 2016

Covered California Enrollment Continues to Surge for January Coverage

Deadline Extended to Dec. 19 to Align With Federal Marketplace

  • Consumers now have through midnight on Monday, Dec. 19 to sign up and have their coverage begin starting Jan. 1.
  • More than 67,000 new consumers selected a plan during the past four days.

SACRAMENTO, Calif. — Covered California is extending a key enrollment deadline for coverage starting Jan. 1 in order to align with a new federal announcement made yesterday that extends the deadline for HealthCare.gov states. 

Consumers enrolling through Covered California will now have through Monday, Dec. 19 at midnight to sign up for health care coverage that will begin on Jan. 1. 

Covered California hopes that by aligning the deadline with HealthCare.gov it will reduce any confusion that consumers may experience after hearing yesterday’s federal announcement, and give consumers the time they need to sign up for coverage.

Just yesterday, Covered California reported 1.2 million renewals (including auto-renewals) of current ACA exchange enrollees, plus another 139,000 new QHP enrollments.

Today they've updated that to tack on another 14,000 new QHPs yesterday alone, bringing the grand total up to around 1,353,000 to date:

Covered California Extends Enrollment Deadline as Consumer Interest Continues to Grow

  • Consumers now have until midnight on Dec. 17 to sign up for health care coverage that will begin on Jan. 1.
  • More than 25,000 new consumers selected a plan during the past two days, which is more than enrolled at this time last year.
  • Open-enrollment plan selections continue to surge ahead of last year’s pace.

SACRAMENTO, Calif. — Thanks to a strong increase in demand, Covered California is giving consumers more time to sign up for health coverage that will start on Jan. 1.

Covered California, the largest state-based ACA exchange (making up over 12% of national exchange QHP enrollments) has only posted one enrollment report so far this period. At the time, they reported 308,000 QHP selections, of which 263,462 were active renewals by existing enrollees and 44,885 were new enrollees signing up. This was as of November 15th...15 days into the enrollment period.

On the one hand, only 14.5% of these are new, which is disturbingly low. On the other hand, part of the reason for this is because so many current enrollees actively renewed...helped, no doubt, by CoveredCA's new policy which allowed them to do so an entire month early (starting on October 1st).

Just moments ago, CoveredCA issued new enrollment data:

Covered California Enrollment Surging as Critical Deadline for Coverage Approaches

Covered California, the largest ACA exchange outside of HealthCare.Gov, just held their board meeting and released some key enrollment data for the first couple of weeks of the 2017 Open Enrollment Period:

EARLY PROGRESS FOR NEW SIGN UPS

44,885

Individuals have selected health care plans as of November 15, 2016. This enrollment reflects a period in which Covered California did not conduct media or enrollment promotion until after November 12th .

Compares to approximately 50,700 for same period 2015 (when Covered California had conducted extensive media and “bus tour” efforts to promote enrollment).

OK, so new enrollments are down about 11% from last year, but as they note, they deliberately held off on actively promoting/advertising until after the election this year.

In a pleasant surprise, 

Me, last Thursday:

There you have it: The states which are 100% on board with the ACA exchange provisions (running their own full state-based marketplace, expanding medicaid and sticking to the original cut-off date for "transitional" policies) average around 18%. If you remove Minnesota from the equation, it's just 15.2%.

Those which implemented only one or two of the above provisions come in at around 26%. In a possibly coincidental quirk, all five fo the "halfway" state exchange states (Hawaii, Oregon, Nevada, Kentucky and New Mexico) just happen to also fall into this category as well, which is completely appropriate.

Finally, states which are fighting the ACA kicking and screaming (no Medicaid expansion, no state exchange and allowing transitional plan extensions as long as possible) are averaging around 30%.

Make of that what you will.

Huh. OK, it looks like three of the ACA state-based exchanges have already launched their 2017 window shopping tools: Idaho, Maryland and California!

The other two announced that their 2017 offerings were open for business via press releases, but it looks like CoveredCA just quietly opened the doors without any fanfare. I stumbled across this by simply visiting the CoveredCA site and clicking the "Shop & Compare" link at the top, which now lists 2017 as the default Coverage Year (you can still choose 2016 if you need to enroll for the rest of this year via SEP). Plugging in some dummy info confirms that the plans are indeed set to start on 01/01/17.

I don't usually post a whole lot about the small group market (other than occasionally trying to track how many SHOP enrollees there are by state and nationally), but this seems like pretty good news given how chaotic the individual market continues to be...

Covered California for Small Business Announces Rate Change and Expanded Coverage Choices for 2017

  • Statewide weighted average rate increase is less than 6 percent.
  • Blue Shield of California expands to Full PPO network statewide.
  • Kaiser Permanente moves into Santa Cruz County.

SACRAMENTO, Calif. — Covered California announced today the rates and expansion plans for its small group health insurance exchange, Covered California for Small Business. The statewide weighted average rate increase is 5.9 percent, for employers and their employees beginning Jan. 1, 2017, which is down from the 7.2 percent increase in 2016.

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