END OF 2018 OPEN ENROLLMENT PERIOD (Connecticut & Maryland)

Time: D H M S

Illinois

(sigh) A couple of weeks ago, I reported that it appeared that Illinois was joining the ranks of states which were going the full "Silver Switcharoo" route for the 2018 Open Enrollment Period, based on an article by Kristen Schorsch in Crain's Chicago Business:

Even before President Donald Trump announced plans last week to nix Obamacare subsidies, the Illinois Department of Insurance raced over the summer to get insurers on board with a strategy to minimize the financial pain of such a move.

...Trump on Oct. 12 ordered the federal government to stop paying the cost-sharing subsidies provided to insurers to defray the cost of covering low-income people. But the Rauner administration has found a way to make the federal government pick up the tab anyway.

Up until a week ago, the possibility of Donald Trump pulling the plug on Cost Sharing Reduction reimbursement payments was a looming threat every day. While it hadn't actually happened yet, most of the state insurance commissioners and/or insurance carriers themselves saw the potential writing on the wall and priced their 2018 premiums accordingly (or at the very least prepared two different sets of rate filings to cover either contingency).

A few spread the extra CSR load across all policies, both on and off the exchange. This seems like the "fairest" way of handling things on the surface, but is actually the worst way to do so, because it hurts all unsubsidized enrollees no matter what they choose for 2018 and can even make things slightly worse for some subsidized enrollees in Gold or Platinum plans.

Protect Our Care is a healthcare advocacy coalition created last December to help fight back against the GOP's attempts to repeal, sabotage and otherwise undermine the Affordable Care Act. This morning they released a report which compiled the approved 2018 individual market rate increases across over two dozen states.

Needless to say, they found that the vast majority of the state insurance regulators and/or carriers themselves are pinning a large chunk (and in some cases, nearly all) of the rate hikes for next year specifically on Trump administration sabotage efforts...primarily uncertainty over CSR payment reimbursements and, to a lesser extent, uncertainty over enforcement of the individual mandate penalty.

Another major state: Illinois. I've decided to scrap the "Low/High Increase" columns since they just confused people and made the table too wide, but replaced them with a new column showing the CSR factor estimate according to the Kaiser Family Foundation. Note that the percent listed will be smaller than Kaiser's estimate for each state, because their numbers only apply to silver plans, not all metal levels.

For instance in Illinois, Kaiser estimates that carriers would have to raise rates by 14% on Silver plans to cover their CSR losses. However, only 64% of Illinois exchange enrollees have silver plans to begin with, so I'm only plugging in about 9%. There are 5 carriers operating on the Illinois individual market (well, really 4, since "Freedom Life" doesn't count). I have the hard enrollment numbers for 4 of the 5; for Health Alliance Medical Plans I used 30,000 based on their 2016 number. Overall, Illinois is looking at around 11.3% w/partial sabotage, 20.3% with full sabotage:

Illinois is pretty straightforward. Assuming 400,000 people enroll in exchange policies by the end of January (a modest 3% increase over last year), I estimate around 275,000 of them would be forced off of their private policy upon an immediate-effect full ACA repeal, plus the 643,000 enrolled in Medicaid expansion as of June 2016, for a total of just over 918,000 Illinoisians kicked to the curb.

As for the individual market, my standard methodology applies:

Zach Tracer reports over at Bloomberg News...

UnitedHealth Group Inc., the biggest U.S. health insurer, is scaling back its experiment in Obamacare markets as its Harken Health Insurance Co. startup withdraws from the two exchanges where it was selling plans.

Harken will not offer individual plans through Obamacare exchanges in Georgia and Chicago in 2017, the company said Thursday in an e-mailed statement. It will continue to offer individual plans off the exchange, Harken said.

As commenter ME notes, there are currently around 22,800 Harken enrollees in Illinois and another 10,500 in Georgia. I have no idea what the on/off exchange ratio is, however, so the number of people who will actually have to shop around will be up to 33,300; assuming, say, 2/3 are on the exchange, that would be roughly 22,000 people.

An important reminder from an anonymous tipster for any Illinois resident who was enrolled in a policy via the now-defunct "Land of Lincoln" Co-Op:

Hey hey. Just wanted to pass some info to you in case you can get it out there. As of last week (not sure the date - either the 15th or the week after) only 34% of LOLH members had taken advantage of the SEP. Spoke with legislators yesterday to get the word out, but since the deadline is Friday, we are trying to get the word out for people to get enrolled.

To review:

Usually when state regulators publicize their approved rate changes for carriers on the independent market, they list the various carriers and the approved average rate changes for each. I then simply plug these into my existing spreadsheet and get a before/after comparison against how much the carriers actually requested.

In the case of illinois, it's a little trickier. Unless I'm missing something, the only official notice the IL DOI has released is this PDF, which--while including lots of useful info about rating areas and so forth--doesn't actually list the overall statewide average approved rate increases by carrier.

Instead, it lists the averages based on metal level, and even then doesn't list all of the plans, just selected ones: Lowest-price Bronze, Lowest and 2nd Lowest-price Silver, and Lowest-price Gold, like so:

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.

(Note: I've had to re-work some of this entry thanks to clarifications from Adam Cancryn about the RBC rule; too many little edits to document each one).

Last week I posted about the latest ugly Co-Op meltdown, this time Land of Lincoln Health (LoL) of Illinois.

As pointed out in my follow-up entry, given the precarious financial state LoL was already in last year, it made little sense that they only asked for fairly nominal rate hikes:

Now, since LoL went belly-up mid-year regardless, obviously even those massive rate hikes weren't enough to save them, so the question is, what would have happened if LoL had gotten their nominal increases as requested?

The most recent ACA/healthcare news out of Illinois was the ugly announcement that Land of Lincoln Health is the latest ACA-created Co-Op to go belly-up, leaving 49,000 people (39,000 on individual plans and 10,000 in the small group market) having to scramble to find new coverage in the middle of the year. This was on top of recent news that UnitedHealthcare is pulling out of dozens of states including Illinois (Humana is also dropping out of a bunch of states, but I don't think Illinois is among them).

Well, nature (and the market) abhors a vacuum, so guess what?

One of the nation's largest health insurance companies plans to enter the Obamacare marketplace in the Chicago area for the first time, bringing new competition as other insurers exit or go out of business.

Commenter "M E" just asked an important question about the Land of Lincoln debacle:

Likely stupid question here, but if they were doing this bad financially that they couldn't even make it though all of 2016, then how come when requesting their 2016 rates last year they (apparently) asked for less than a 10% bump?

I mentioned this yesterday in my "back from vacation" post, but it's important enough to deserve a separate follow-up post...especially given the clarification about the coverage cut-off date:

Land of Lincoln coverage will end Oct. 1 for individual enrollees

Land of Lincoln Health's insurance coverage for its individual enrollees will end Oct. 1, according to the Illinois Department of Insurance.

The agency posted the news on Land of Lincoln's website. A green banner now greets visitors to the website with the headline, "Important notice to all members" with a link taking them to information about the Chicago-based insurer's impending shutdown. The notice comes a week after the agency moved to seize control of the financially troubled Chicago-based insurer.

All last fall I documented the saga of the Risk Corridor Massacre, which helped to wipe out a dozen ACA-created co-ops and put many of the remaining ones (along with some private carriers) on shaky ground.

Earlier this week I noted that one of the remaining co-ops, HealthyCT of Connecticut, is the latest to go belly-up...due in large part to a different program, "Risk Adjustment". The irony in both cases is that both programs were supposed to be designed specifically to help ensure that "little guy startups" such as the co-ops would be protected from dissolution during the unstable first few years of the ACA exchanges. Instead, developments in both programs have served to help destroy them.

As I noted the other day, the Risk Adjustment program seems to be backfiring:

As Richard Mayhew noted a few days ago over at Balloon Juice:

A couple of weeks ago Adam Cancryn reported that several of the 11 remaining ACA-created Co-Ops had actually reported small profits for the first quarter of 2016.

Today, I'm afraid Cancryn says that this is not the case for Land of Lincoln Mutual Health Insurance Co., the Illinois Co-Op...although they are hoping to take advantage of the announcement made just over the weekend which now allows the Co-Ops to seek outside funding:

Land of Lincoln Mutual Health Insurance Co. plans to look for outside investors to boost its financial resources after federal regulators indicated they would loosen funding restrictions on consumer operated and oriented plans.

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