Florida

A couple of years ago, an ACA-related "case study" story went viral for a week or so about a man from Fort Mill, South Carolina by the name of Luis Lang.

Initially, the story seemed to be about a man who railed against Obamacare while both taking absolutely no responsibility for failing to take advantage of the benefits of the law which he was entitled to and simultaneously blaming President Obama for the failure of his own GOP-controlled state to expand Medicaid under the law. Several people wrote up articles ripping Mr. Lang to shreds over his seeming hypocrisy, myself included.

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I crunched the numbers for Texas, it's actually easier to figure out how many people would lose coverage if the ACA is repealed in non-expansion states because you can't rip away healthcare coverage from someone who you never provided it to in the first place.

My standard methodology applies:

  • Plug in the 2/01/16 QHP selections by county (hard numbers via CMS)
  • Project QHP selections as of 1/31/17 based on statewide signup estimates
  • Knock 10% off those numbers to account for those who never end up paying their premiums
  • Multiply the projected effectuated enrollees as of March by the percent expected to receive APTC subsidies
  • Then knock another 10% off of that number to account for those only receiving nominal subsidies
  • Whatever's left after that are the number of people in each county who wouldn't be able to afford their policy without tax credits.

In the case of Florida, assuming they hit 1.825 million exchange enrollees this year, it comes to a whopping 1.35* million people.

*(updated 1/30/17 w/revised estimates)​

I appear to have something of a semi-exclusive here, if only because the Florida DOI isn't formally posting these documents on their website until tomorrow due ot the holiday weekend:

Office Announces 2017 PPACA Individual Market Health Insurance Plan Rates to Increase 19% on Average

TALLAHASSEE, Fla. – The Florida Office of Insurance Regulation announced today that premiums for Florida individual major medical plans in compliance with the federal Patient Protection & Affordable Care Act (PPACA) will increase an average of 19% beginning January 1, 2017. Per federal guidelines, a total of 15 health insurance companies submitted rate filings for the Office’s review in May. These rate filings consisted of individual major medical plans to be sold both on and off the Exchange. Following the Office’s rate filing review, the average approved rate changes on the Exchange range from a low of -6% to a high of 65%. This information can be located in the attached “Individual PPACA Market Monthly Premiums for Plan Year 2017*” document.

via Bob Herman of Modern Healthcare:

The Affordable Care Act's exchanges have not been a bust for every health insurer. Florida's Blue Cross and Blue Shield affiliate made a profit of almost a half-billion dollars on the ACA's new individual plans last year.

The substantial ACA exchange losses exhibited by large health insurers—such as Health Care Service Corp., Highmark, Humana and UnitedHealth Group—have emboldened the law's critics and worried investors about whether the new marketplaces will ever achieve sustainability.

Yet many other companies, including Medicaid insurers Centene Corp. andMolina Healthcare and now Florida Blue, have had no difficulties making money on the new ACA plans, which often have narrow networks of hospitals and doctors as well as high deductibles.

As with California, there's no actual individual carrier rate/market share breakdown available, but the source is the DOI itself, so I'm assuming "average" means weighted average:

Fifteen health insurers want an average 17.7 percent increase in premiums for Affordable Care Act individual plans, Florida officials said Thursday — higher than last year’s approved average of less than 10 percent.

...In Florida, 15 companies also asked for an average 9.6 percent increase for small group plans, said Amy Bogner, spokeswoman for the state’s Office of Insurance Regulation.

The companies were not identified individually because they claimed trade secrecy, she said.

It sounds like BCBS of Florida is seeking around 9.8 - 11.6% hikes for the individual market, and 5.2 - 8.7% hikes for the small group market:

This may seem like common knowledge now, but in 2014, it felt like I was one of the only people who recognized that there were millions of people enrolling in ACA-compliant policies off of the ACA exchanges, directly via the insurance carriers themselves. My best estimate for 2014 was that in addition to the 7 million or so exchange-based individual market enrollees, there were another roughly 8 million people who enrolled off-exchange (although several million of those were in non-ACA compliant policies).

When I crunched the numbers for Florida's individual market back at the beginning of August, I had to make certain assumptions based on missing data. Even though I had hard numbers for many of the missing market share/enrollment fields, there were still major gaps, especially on the "companies requesting increases of under 10%" side.

I ended up with three potential scenarios for the requested weighted average increase in the Sunshine State: A best-case scenario of 8.6%, a "most likely" scenario of 10.3% and a worst-case scenario of 12.0%. In the interest of caution, I plugged the "most likely" number (10.3%) into my national average spreadsheet, and assumed it'd be somewhere between that and 12% publicly.

Last week I took the known 2016 Florida rate increase requests (around 14.7% weighted average for 10 companies with around 713,000 enrollees) and took my best shot at trying to estimate what the rest of Florida's ACA-compliant individual market might look like.

In order to do this properly, I'd need 2 pieces of data: First, the weighted average increase request for the 6 additional companies which I didn't already have rate requests for; and second, the total ACA-compliant enrollment number for those 6 companies.

The Rate Review database at Healthcare.Gov is a very useful tool for any insurance company requesting rate increases above 10%, but it's completely useless for requests below 10%. As such, I have hard data on the requested increases for about 600,000 Florida residents:

If Florida's entire ACA-compliant individual market was only 600K people, that would be the end of the story.

However, Florida actually has 16 different insurance companies selling individual policies...and the other 9 are all asking for lower than 10% hikes. After poking around the Florida Office of Insurance Regulation website as well as contacting the department directly, I've been able to pull together covered lives data for all 16, and requested rate change data for 3 more of them...2 of which are actually requesting rate decreases. When I add those 3 companies into the mix, the picture changes like so:

Of the 6.5 million people who would lose their federal tax credits, and almost certainly their healthcare coverage (completely apart from the additional 6.5 million who would have an economic boulder dropped on them indirectly) in the event of a King v. Burwell plaintiff win, over 1/3 live in just two states: Florida and Texas. 1.34 million Floridians and 846,000 Texans would be be among the direct casualties...close to 2.2 million between the two of them.

Given that both are completely run by off-the-rails batcrap-insane Republicans in the House, Senate and Governor's office, it's safe to say that you can expect a LOT of stories like the following from the Sunshine and Lone Star states.

Ho. Lee. Crap.

Check out this press release from Florida Governor and Lord Voldemort impersonator Rick Scott:

Gov. Scott: We Will Begin Working Immediately on a Budget to Continue Critical Programs & Start Conversation on Healthcare Access and Cost

On April 30, 2015, in News Releases, by Currie Dickerson

TALLAHASSEE, Fla. – Governor Rick Scott released the following statement today upon the adjournment of the Florida Senate upon the call of the President, and after the Tuesday adjournment of the Florida House:

“Now that the Florida Senate and House have adjourned, we must immediately turn our focus to how we can work together to craft a state budget before July 1st that continues funding for critical state services. There were no discussions about Medicaid expansion under Obamacare before the legislative session began. Today, it is clear that a thorough analysis of how healthcare can be reformed to improve cost, quality and access is needed, apart from the budget process.

bla bla bla...

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.

I have a ton of ACA-related stories cluttering up my in-box again; here's some of the more interesting ones, all regarding ACA Medicaid Expansion:

MICHIGAN:

For months now, I've been a bit obsessed with figuring out how my home state's Medicaid expansion enrollment has managed to reach as high as 21% more people than were supposedly even eligible for the program. Estimates last year ranged from 477,000 - 500,000, yet enrollment in Healthy Michigan (Gov. Snyder's name for Obamacare Medicaid Expansion) currently sits at a whopping 579K, less than 1 year into the program.

Remember "Florida Health Choices", the brainchild of Republican Senator Marco Rubio which was supposed to be the Florida GOP's response to the Affordable Care Act health insurance exchanges?

The Florida Republican Party flushed $900,000 in startup funds into a website/"exchange" which signed up a whopping 30 paying customers in 6 months, at a cost of $30,000 apiece...or between 46x - 81x as much per enrollee as the "wasteful" HealthCare.Gov.

Of course, it didn't help that "Florida Health Choices" didn't actually sell, you know, "health insurance" but was basically hawking discount coupons for dental checkups and the like.

Remember all last summer and into the fall when I kept pointing out to anyone who would listen that just because the official Open Enrollment period had ended back on March 30th (or April 15th, depending on your POV), there were still a good 9,000+ people per day enrolling via the ACA exchanges due to major life changes?

Of course, those people being added were also being cancelled out to some degree by people dropping their policies (or being dropped whether they liked it or not due to non-payment or immigration/residency issues). From what I could tell, the additions seemed to be outnumbering the subtractions for most of the summer, up until around August, at which point the trend reversed. However, it was difficult to know this for certain until the CMS head unexpectedly mentioned that 7.3 million people were still enrolled as of mid-August (going up!), followed by a drop to 7.1 million as of mid-October (going down!).

Pages