A few weeks ago, I posted a lengthy, in-the-weeds explainer about how the ACA's Medical Loss Ratio (MLR) provision works. The short version is that ever since the ACA went into effect in 2011 (3 years before newly-sold policies had to be ACA compliant), to help reduce price gouging, insurance carriers have been required to spend a minimum of 80% of their premium revenue (85% for the large group market) on actual medical claims.
Put another way, their gross margins are limited to no more than 20% (or 15% in the large group market). Remember, that's their gross margin, not net; all operational expenses must come out of that 20% (15%). The idea is that they should be spending as much of your premium dollars as possible on actual healthcare, as opposed to junkets to Tahiti or marble staircases in the corporate offices, etc. Anything over that 20% (15%) gross margin has to be rebated to the policyholder.
After several years with four carriers participating in their ACA individual market, the Peach State is gaining not one but two additional carriers this year: CareSource and Oscar are joining Alliant, Ambetter/Centene, Blue Cross Blue Shield and Kaiser. Unlike a lot of the states I've crunched numbers for recently, I was able to acquire hard enrollment numbers for every single Georgia carrier...including both the Individual and Small Group markets, which is a rarity this year!
Statewide, GA's individual market carriers are requesting average unsubsidized 2020 rate hikes of just 2.4%, while the small group carriers are looking for a 12.8% average increase:
Long-time readers of this site may remember that I have a "special place" in my heart (more like in the pit of my stomach) for Ralph Hudgens, the now-former Georgia state Insurance Commissioner, ever since I read about this ugly incident way back in 2013:
“Let me tell you what we’re doing (about ObamaCare),” Georgia Insurance Commissioner Ralph Hudgens bragged to a crowd of fellow Republicans in Floyd County earlier this month: “Everything in our power to be an obstructionist.”
After pausing to let applause roll over him, a grinning Hudgens went on to give an example of that obstructionist behavior, this one involving so-called “navigators” who are being hired to guide customers through the process of buying health insurance on marketplaces, or exchanges, set up under the federal program.
UPDATE: It's been pointed out that the Supreme Court has ruled that minors can't receive the death penalty, so I guess that means "only" life in prison for them. If they're 18 or older, however...
On the other hand, several people have noted that an 11-year old pelvis isn't generally developed enough to even deliver a baby safely, along with other health risks, so it could very well be a death sentence regardless, so I'm leaving the headline as is.
Gov. Brian Kemp will ask the Georgia Legislature and the federal government for flexibility to improve access to government-funded health insurance for the state’s poor and middle class.
His administration told The Atlanta Journal-Constitution on Thursday that it will back a measure that seeks two separate federal “waivers” to Medicaid and the Affordable Care Act to tailor new programs to Georgia’s needs.
This sounds potentially promising, but...
...The ACA waiver, which he outlined on the campaign trail, aims to stop premiums on the health insurance exchange market from rising so fast. A second push, which emerged after his election, would raise the possibility of a partial expansion of Medicaid to some of Georgia’s poorest residents.
So, it's over, right? Well...not quite. The 2019 ACA Open Enrollment Period officially ended last night...but only in 43 states. In the remaining seven (+DC), Open Enrollment hasn't ended yet. 2019 ACA Open Enrollment is still ongoing for nearly 10% of the population!
In Massachusetts, open enrollment runs through Jan. 23rd, 2019 for coverage starting February 1st
Under Georgia law, if no candidate ends up with more than 50% of the total vote, the top two candidates move on to a run-off election, so if Kemp's lead ends up dropping by around 13,000 more votes as the thousands of remaining ballots are counted, it's on to a run-off between the two.
Busy day today! State insurance regulators around the country appear to have decided to start posting approved 2019 ACA rate filings all at once; within the past week, Vermont, Ohio, Delaware and North Carolina have posted theirs...and now you can add Georgia to the list:
The Obamacare rates for next year are in, and it’s a first: Rates are going down.
Following years of steep price hikes, two of the four companies that offer plans on the Affordable Care Act exchange in Georgia, also known as Obamacare, have proposed to lower their rates next year from what they charged in 2018.
According to figures for the individual insurance market released Thursday by the state Department of Insurance, Blue Cross Blue Shield of Georgia is proposing a tiny decrease in premiums for next year, with 2019 premium prices that are on average 0.3 percent lower than 2018’s premiums. Alliant Health Plans is decreasing its premiums by 10 percent.
Whew! Georgia only has 4 carriers participating in the individual market, but tracking down some of the data was a royal pain in the butt, especially Ambetter/Centene, which not only buried the numbers I needed inside a whopping 1,900-page PDF file, but the actual average requested rate increase wasn't even included; for that I had to check a different file. Yeesh.
The good news is that carriers in Georgia are only requesting around a 6.1% average rate increase for ACA-compliant individual market policies next year.
The bad news is that if it weren't for the ACA's individual mandate being repealed and the Trump Administration's expansion of #ShortAssPlans, 2019 premiums would likely be dropping by around 5.8% instead.
Now that it appears that the full list of states and counties eligible for hurricane (or windstorm, in the case of Maine) Special Enrollment Periods (SEP) has settled down, Huffington Post reporter Jonathan Cohn asked an interesting question:
How if at all do you allow for the extensions in FL, TX, etc.? Or, to put another way, how many post-Dec 15 signups through https://t.co/bhGNSognZK do you expect?
The closest parallel to this particular situation I can think of was the #ACATaxTime SEP back in spring 2015. In that case, it was the first year that the ACA's (defunct as of this morning) Individual Mandate was being enforced, and a lot of people either never got the message about being required to #GetCovered or at least pretended that they didn't.
INSURANCE DEPARTMENT RELEASES PROPOSED RATES FOR 2018 HEALTHCARE EXCHANGE
Atlanta – Insurance Commissioner Ralph Hudgens announced today that his office had submitted proposed 2018 health insurance rates to the Centers for Medicare and Medicaid Services (CMS) for the federally-facilitated Healthcare Exchange for final federal approval.
“Today my office submitted 2018 Obamacare rates to Washington D.C. for approval,” Hudgens said. “In its fifth year, Obamacare has become even more unaffordable for Georgia’s middle class with potential premium increases up to 57.5 percent. I am disappointed by reports that the latest Obamacare repeal has stalled once again and urge Congress to take action to end this failed health insurance experiment.”
Including Georgia, I've now compiled initial 2018 unsubsidized individual market rate hike requests for 17 states...and Georgia's carriers are asking for by far the highest overall average increase, even assuming no Trump/GOP sabotage tax.
There appear to be four carriers which have filed to sell individual market plans in Georgia next year: Alliant, Ambetter (aka Celtic, aka Centene...for God's sake, pick one name, guys, willya??), Anthem Blue Cross Blue Shield and Kaiser Health Plan.
Over the past few months, my Congressional District Breakdown tables estimating how many people would likely lose healthcare coverage if the ACA were to be "cleanly" repealed (with no replacement) have gotten a lot of attention. This was followed by the Center for American Progress (CAP) running their own estimates of how many would likely lose coverage if, instead of a "clean" repeal of the ACA as a whole, the ACA were to be partially left in place, with the GOP's AHCA (Trumpcare) bill, which dramatically changes the ACA, being signed into law instead.
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 Georgia, assuming 567,000 people enroll in exchange policies by the end of January, I estimate around 396,000 of them would be forced off of their policy upon an immediate-effect full ACA repeal.