START OF 2018 OPEN ENROLLMENT PERIOD

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Hawaii

While I've been embroiled in the sturm und drang at the national level, Louise Norris of healthinsurance.org has been reporting on some important stuff happening at the state level:

HAWAII:

Hawaii no longer has a SHOP exchange; Lawmakers consider bill to preserve the ACA and expand Medicaid to 250% FPL

As of 2017, Hawaii no longer has a SHOP exchange for small businesses. The State Department of Labor and Industrial Relations has an FAQ page about this.

...Hawaii’s waiver aligns the ACA with the state’s existing Prepaid Health Care Act. Under the Prepaid Healthcare Act, employees who work at least 20 hours a week have to be offered employer-sponsored health insurance, and can’t be asked to pay more than 1.5 percent of their wages for employee-only coverage (as opposed to 9.69 percent under the ACA in 2017). 

As I'm sure some readers have noticed, I haven't posted any updates since Friday, which is highly unusual for me, especially with open enrollment rapidly approaching. I'm afraid that due to an unfortunate coincidence of timing, I have an outside personal commitment which will be eating up a lot of my time for the next 4 weeks; as a result, expect posts to be lighter than usual.

Anyway, Hawaii's official 2017 approved rates came out the other day (thanks to commenter "M E" for the heads up):

Kaiser's 25.9% request was approved as is; HMSA's 43.3% was shot down originally; they later resubmitted it at 35%, which was then approved.

You may also notice that I've started making sure to include UNSUBSIDIZED in the headlines for all of these rate hikes. This is vitally important to remember, even if it's only relevant to around 50% of individual market enrollees.

Lots of stuff happening fast & furious these days as #OE4 approaches. Instead of individual posts, I'm gonna cram 7 state updates into a single one...and am also cheating a bit by cribbing off of excellent work by Louise Norris over at healthinsurance.org (which is fair, since she also gets some of her data from me as well):

ALABAMA: Here's what my requested rate hike table looked like for Alabama on August 1st:

Updates: Norris Confirms that:

As I noted Monday morning, I believe that August 1st was the deadline for every state to submit their 2017 rate filings, meaning that the 14 states missing from my Requested Rate Hike Project are finally available to be plugged into the spreadsheet. I'll also be going back through the other states I've been tracking since as early as April to see which ones require updates due to carriers dropping out, joining in or resubmitting their rate requests.

There are only two insurance carriers participating in Hawaii's individual market next year: The Hawaii Medical Service Association (HMSA) and the Kaiser Foundation Health Plan.

But actually, he thought as he re-adjusted the Ministry of Plenty’s figures, it was not even forgery. It was merely the substitution of one piece of nonsense for another. Most of the material that you were dealing with had no connexion with anything in the real world, not even the kind of connexion that is contained in a direct lie. Statistics were just as much a fantasy in their original version as in their rectified version. A great deal of the time you were expected to make them up out of your head. For example, the Ministry of Plenty’s forecast had estimated the output of boots for the quarter at 145 million pairs. The actual output was given as sixty-two millions. Winston, however, in rewriting the forecast, marked the figure down to fifty-seven millions, so as to allow for the usual claim that the quota had been overfulfilled. In any case, sixty-two millions was no nearer the truth than fifty-seven millions, or than 145 millions. Very likely no boots had been produced at all. Likelier still, nobody knew how many had been produced, much less cared. All one knew was that every quarter astronomical numbers of boots were produced on paper, while perhaps half the population of Oceania went barefoot.

As anyone who's been following the ACA exchange saga over the past few years knows, the original idea was that all 50 states (+DC) would establish their own, individual healthcare exchange, including their own website/technology platform for enrolling residents in private policies (QHPs), Medicaid (supplementing or replacing whatever existing Medicaid system they already had) and small business policies (the ACA's SHOP program). In addition, each state exchange would also have their own board of directors, marketing department, support call center, fee structure for covering the cost of operations and so on.

If things had worked out that way, there would have been 51 different websites where people would enroll in ACA policies, each one independently branded.

Hawaii was one of the first states I ran a weighted average rate increase for, way back in July. With only 2 insurance carriers offering individual market policies either on or off the ACA exchange, and a small membership to being with, it was pretty basic: 

For 2016, HMSA has proposed a 45.5 percent rate increase for their individual HMO plan, and nearly a 50 percent rate hike for their individual PPO plan (49.1 percent overall). The carrier justified their rate hikes based on claims costs, explaining that while virtually everyone in Hawaii was already insured, the uninsured pool – many of whom purchased new ACA-compliant plans – had significant medical needs.

Ouch. Yup, that's a pretty ugly requested increase, no way around it.

The following day, Kaiser proposed an 8.7 percent rate increase for their individual market policies.

If approved as is, this would have resulted in a 33.7% average rate increase, when weighted by market share between the two companies.

Thanks once again to Louise Norris for doing the heavy lifting in the Aloha State:

Hawaii Health Connector offers individual plans from two carriers: BCBS’s Hawaii Medical Service Association (HMSA), and Kaiser Permanente.

For 2016, HMSA has proposed a 45.5 percent rate increase for their individual HMO plan, and nearly a 50 percent rate hike for their individual PPO plan (49.1 percent overall). The carrier justified their rate hikes based on claims costs, explaining that while virtually everyone in Hawaii was already insured, the uninsured pool – many of whom purchased new ACA-compliant plans – had significant medical needs.

Ouch. Yup, that's a pretty ugly requested increase, no way around it.

The following day, Kaiser proposed an 8.7 percent rate increase for their individual market policies.

In 2014, Hawaii's enrollment numbers were pretty bad, but they were at least consistent: About 400 through the end of November; 2,200 at the end of December; 3,600 at the end of January, 4,600 at the end of February and about 8,600 through mid-April. Their cumulative total through the end of the off-season last year was just shy of 11,000, which again, was pretty in line with what I'd expect.

As you can see from the reposts below, for 2015, Hawaii's numbers have been all over the place, making sense some days and completely out of whack on others. The official HHS Dept. ASPE report has Hawaii with 12,635 QHPs selected for 2015 as of Feb. 21st...which sound about right to me (ie, that's a pretty lame number, but it's still around a 47% increase over 2014). Then, a few days ago, CMS released the effectuated enrollment numbers as of 3/31. For Hawaii, this number is 8,200...a 35% drop. While that's a disturbingly heavy drop (the other states averaged just a 13% "drop" overall), it's at least plausible.

For months now, the ACA state exchanges in small states like Rhode Island, Vermont and Hawaii have been struggling mightily with either funding issues (RI) or both funding and technical problems (VT & HI). Most of my own focus has been on the 2 northeastern states.

Today, however (thanks to Sabrina Corlette for the heads' up), the HI Health Connector has apparently skipped ahead a few chapters and concluded that due to their inability to convince the state legislature to pony up more cash (they were originally seeking $10 million but only $2 million was approved), they're gonna have to close up shop:

May 09--The Hawaii Health Connector has prepared a contingency plan to shut down operations by Sept. 30 after lawmakers failed to pass legislation to keep the state's troubled Obamacare insurance exchange afloat.

The ACA exchange enrollment reports out of Hawaii have been continually confusing as hell. One day it's 16,000 (more than twice 2014's total); a month later it's only 13,300; then just hours later, I receive "confirmation" (directly from the exchange director, supposedly) that it's actually 23,000...specifically for 2015 policies.

While this was screaming out as a big red flag, I grudgingly accepted it...only to have the rug yanked out from me when the official ASPE report came out in March, giving the official final number as 12,625...which is right in line with what I was expecting in the first place (around a 50% increase over their total in April 2014, and 17% over their total as of September 2014).

The impending King v. Burwell Supreme Court decision will cast an even larger shadow over the ACA over the next 2 months (the decision is expected to be announced in June), as exchanges in 6 of the 14 states running their own (State-Based Marketplaces, or SBMs) are at risk of either being abandoned, dissolved or otherwise moved over to the federally-run Healthcare.Gov exchange:

The federal government is threatening to take over Hawaii's health insurance exchange within months and has restricted grant money to support operations of the Hawaii Health Connector.

Jeff Kissel, the Connector's executive director, told lawmakers at a briefing Thursday that if the exchange created by the Affordable Care Act does not get state funding soon, the federal government will abolish Hawaii's marketplace and run it directly.

This isn't an exact apples-to-apples comparison, since the Massachusetts number includes the "overtime" extension period while the other 5 states only run through 2/15/15, but I thought it would be useful to see how the 6 exchanges which had widespread technical issues last year fared this time around. Obviously  other states like Washington and California had some snafus, but these are the ones which were seriously hosed last year to the point of requiring massive overhauls or which were completely scrapped in favor of a new platform (I'm not including HC.gov itself here since everyone already knows what massive technical improvements they've made).

The chart below refers specifically to QHP selections only (whether paid or not), and compares the 2015 open enrollment period (11/15/14 - 2/15/15...or 2/26 in the case of MA) against the 2014 open enrollment period (10/1/13 - 4/19/14). I've also included some notes for context.

The enrollment data from Hawaii has been sporatic and a bit squirrelly, with the few numbers being thrown around sometimes including the cumulative plan selections including 2014 enrollees whether they renewed for 2015 or not. When I posted my last Hawaii update, I was suspicious (at 16.1K, it was nearly twice last year's tally), but the article seemed pretty confident about the numbers, so I went with it.

This evening, I was immediately concerned when I saw the lede...

The Hawaii Health Connector said about 13,356 residents signed up for Obamacare coverage in the three-month enrollment period that ended Sunday.

Well this one was unexpected: It's not a formal press release, but this story from the Hawaii Reporter--which actually has a pretty negative slant to it--is chock full of actual, current enrollment data points for Hawaii...and they're pretty good, relatively speaking.

None of the numbers are precise--they're all rounded off...but it's still a breath of fresh air from the Aloha state, and brings the number of states which haven't provided renewal data down from 3 to two (of course, the other two are California and New York, but still...)

Anyway...

...The Connector had about 1,000 people enrolled at this time last year. As of Thursday, that number had grown to 16,000.

...More than 365 small businesses, with 2,400 enrollees, have joined the Connector through the Small Business Health Options Program, or SHOP, in part because of tax deductions available to them, Kissel said.

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