Indiana

The last official ACA Medicaid expansion enrollment number I have recorded for Indiana (via their modified "Healthy Indiana 2.0" program) was 290,000 people way back in July 2015. At the time, the maximum potential HIP 2.0 enrollment total was 680,000 Hoosiers, made up of 350,000 newly covered plus another 330,000 being transferred over from the HIP 1.0 program.

This NPR article from a couple of weeks ago states that as of January, "the Healthy Indiana Plan that he established in 2015 as the state's governor has brought Medicaid coverage to more than 350,000 people." However, that number is a bit confusing given that they were also supposedly transferring the other 330K over from the other program as well. I'm not sure if 350K refers to total HIP 2.0 enrollment or only those who were previously uninsured.

Normally I post screenshots from the revised/updated SERFF filings and/or updates at RateReview.HealthCare.Gov, but it takes forever and I think I've more than established my credibility on this sort of thing, so forgive me for not doing so here. Besides, #OE4 is approaching so rapidly now that this entire project will become moot soon enough, as people start actually shopping around and finding out just what their premium changes will be for 2017.

The other reason I'm not too concerned about documenting the latest batch of updates/additional data is because in the end none of it is making much of a difference to the larger national average anyway; no matter how the individual carrier rates jump around in various states, the overall, national weighted average still seems to hover right around the 25% level.

Still, for the record, here's the latest...in four states (Iowa, Indiana, Maine & Tennessee) I've just updated the requested and/or approved average increases. In the other four (Massachusetts, Montana, North & South Dakota) I've added the approved rate hikes as well.

(sigh) I thought that last Friday was the deadline for carriers to decide whether they were in or out of the exchange for 2017, but between today's news out of Tennessee and now this, apparently that deadline only applies to those who will be participating in the 4th Open Enrollment Period:

Indiana University Health Plans is pulling out of the Obamacare marketplace in Indiana, just one month after state regulators approved its proposal to raise premiums nearly 15 percent.

IU Health Plans said Monday afternoon it had “restructured its product offerings for 2017” and no longer will be offering individual plans on the exchange. It said the change was necessary “to adapt to new market dynamics” as well as uncertainty created by withdrawals of several other insurers.

Believe it or not, Indiana's individual market situation is actually among the brighter spots this year. While three carriers are dropping off of of the ACA exchange market (and Physicians Health Plan is dropping off-exchange policies as well), they're also seeing the addition of a new carrier (Golden Rule), and one major carrier, Celtic, actually requested and received an average reduction in their monthly premiums, which is pretty rare this go around.

Unfortunately, the overall average approved statewide increase, while still lower than most of the other states so far, is actually slightly higher than the requested average. Every carrier got what they asked for with the exception of Indiana University, which asked for a 9.9% hike but was approved for a 14.9% increase. This bumped the statewide average up from 17.7% to 18.5%:

The average premiums range from an increase of 29 percent by Indianapolis-based Anthem Inc. to a decrease of 5.3 percent by Chicago-based Celtic Insurance Co.

And the hits keep coming:

Physicians Health Plan of Northern Indiana announced Tuesday that it will quit selling individual insurance coverage next year through the federal Affordable Care Act.

The nonprofit PHP becomes the second insurer to announce it is leaving the HealthCare.gov insurance marketplace that serves residents of northeast Indiana. UnitedHealthcare said last spring it would drop out of the exchange in most states, including Indiana.

Four other insurers offered individual policies through HealthCare.gov this year in the Fort Wayne area and apparently will continue to do so in 2017. Insurers had until Tuesday to notify the state of their plans, and all four are among federal marketplace filings the Indiana Department of Insurance submitted Tuesday to the Department of Health and Human Services.

Fort Wayne-based PHP said it is paying $1.20 in medical expenses for every dollar it receives in premium payments from HealthCare.gov customers and has lost millions of dollars on the policies. 

Last year, Indiana was one of only two states to see virtually flat year over year premium increases on the ACA-compliant individual market, with rates going up a mere 0.7% on average. This year, unfortunately, that won't be the case...although at least one carrier, Celtic, is reducing their average rates by over 5%.

The good news is that I was able to track down the average rate change for all 6 carriers offering individual plans in Indiana (UnitedHealthcare is dropping out of the market, and I'm not sure what's going on with Aetna and Coordinated Care Corporation, both of which do have listings in Indiana's SERFF database for 2017...but neither of which has any actual filings listed. I presume these are placeholders for them to potentially enter the state market, which would be a good thing (and which Aetna has already indicated they might be doing next year). In addition, Golden Rule says that they'll be offering ACA-compliant policies starting next year as well (mainly for their current "transitional" enrollees).

The bad news is that while I've hunted down the current enrollment numbers for 5 of the 6 renewing carriers, one of them, MDwise, is frustratingly unknown, making it tricky to calculate a weighted average rate hike. Actually, I only have hard numbers for 4 carriers; for Celtic I had to cheat a bit by using their projected enrollment for next year. At 197,000 member months, that's an average of around 16,400 enrollees both on & off the exchange.

Without MDwise included, the average of the other 5 carriers comes in at 19.25%. However, MDwise is only (only is relative, I realize) requesting an 11.5% average hike, so any additional enrollees from them would bring that average down somewhat. The problem is figuring out how many current enrollees MDwise has:

A couple of weeks ago, my post on Indiana's average 2016 rate increases on the individual market would likely be very close to flat, based on partial enrollment data (i.e., they provided the rate data for every insurance company, but enrollment data for only one of them). The one company they provided enrollment information for, Physicians Health Plan, also happens to have the highest average rate hike, 13.5%.

However, I noted that since a) Physicians only holds around 4% of Indiana's market, and b) several of the other companies were approved for rate decreases (up to -19% for Mdwise Marketplace), it's entirely possible that the state could be looking at an overall rate decrease, or a very low increase at worst. I decided to split the difference and go with a flat zero percent change until further notice.

Today, Louise Norris has come through again:

Last year, while most state-wide average premium rates increased somewhat (averaging around 5.5% overall nationally, give or take), there were a few states which actually saw rate decreases from the year before: Arkansas, Mississippi and New Mexico saw overall decreases on their individual markets, while the District of Columbia and Hawaii saw decreases on their Small Business markets.

A few weeks ago I reported that Indiana's implentation of the ACA's Medicaid expansion provision, which kicked off at the end of January, was already up to 237,000 enrollees.

Today, that number is significantly higher yet:

Industry representatives say Indiana's expanded health care program for low-income residents has functioned smoothly in the months since it was implemented following federal approval.

The federal Centers for Medicare and Medicaid Services in January approved expanding the existing Healthy Indiana Plan into a larger program that Gov. Mike Pence has dubbed HIP 2.0. That program uses federal Medicaid funds under President Barack Obama's health care law to cover people with incomes under 138 percent of the federal poverty level.

State enrollment in HIP 2.0 has climbed to nearly 290,000 participants, with about 60 percent of those people under age 40, according to state figures presented Thursday during a public hearing in Indianapolis on the program.

Yes, with the All King v. Burwell, All The Time® mindset this month, it's easy to forget that the core purpose of this website is supposed to be to track the enrollment numbers...and between KvB and this being the middle of the off-season, it's no wonder that there hasn't been much of that lately.

With that in mind, thanks to Andrew Sprung for this tidbit...Indiana is one of the states which initially refused to expand Medicaid under the Affordable Care Act, but which came around earlier this year, starting enrollment in their (heavily modified) Medicaid expansion program at the end of January.

Five months later, it looks like it's off to a pretty good start:

"The Healthy Indiana Plan ... is aspirational," said Brian Neale, the governor's health policy director. "We believe that individuals, if offered the opportunity, will make the right choices."

This Just In...

Gov. Pence gets federal OK for Medicaid alternative

Indiana has been given the green light to expand its Healthy Indiana Plan, which would offer insurance to an additional 350,000 Indiana residents who currently lack insurance.

The state will begin taking applications immediately for its so-called HIP 2.0 plan, for which coverage begins Feb. 1, Gov. Mike Pence announced Tuesday morning at a packed speech at St. Vincent Health.

So, what makes this different from standard Medicaid expansion?

Indiana is the only state to apply private market measures, such as requiring participants to make monthly contributions to help cover the benefit.

Anyone who falls below 138 percent of the federal poverty level will now be eligible to enroll in what the state is terming the Healthy Indiana Plan Plus. The plan includes dental and vision benefits, as well comprehensive prescription drug benefits.

Participants in this plan will be expected to make contributions of between $3 and $25 per month, or about 2 percent of the annual income for the year.

Rounding out today's "Net QHP Attrition Rate" Trifecta is Indiana, which, while not as deep-red as Tennessee, a) also has a Republican administration; b) hasn't expanded Medicaid; and c) refused to set up their own exchange.

This makes it all the more of a positive surprise to see that their ACA exchange QHP attrition rate is even lower than Tennessee--in fact, it's under 1%!!

The April 19, 2014 total for Indiana was 132,423 Hoosiers. Assuming an 88% payment rate and you get about 116,500.

I just learned that the number currently enrolled as of mid-October stands at 115,800...a drop of just 0.6%.

This piece by Salon's Simon Maloy pretty much nails it on the head:

At this point it’s near-impossible to maintain the fiction that the Affordable Care Act is failing or that the Republicans have a coherent strategy for unmaking it. One by one, Republican-led states are abandoning their opposition to implementing the ACA.

This is obviously an unwelcome trend for groups like Americans for Prosperity, the Koch brothers’ main outlet for political activism.

...Now contrast AFP’s treatment of Pence with how the group reacted to Rick Snyder, the Republican governor of Michigan...AFP Michigan opposed the plan from the get-go.

...So what explains the disparate treatment? It may be that AFP is finally starting to see the writing on the wall and coming to grips with the slow, steady erosion of the Republican anti-Obamacare bulwark. But it could also be the fact that Mike Pence is the Koch brothers’ golden boy.

Presented without comment (except for my emphasis):

INDIANAPOLIS (AP) — Indiana residents will have more than triple the number of health insurance plans to choose from when the federal insurance exchange enrollment period starts in November, according to a state official.

Indiana Department of Insurance attorney Tina Korty told a legislative panel Thursday that some insurers took a “wait-and-see” approach during the first year of the exchanges under the Affordable Care Act.

Nine companies will offer a total of 975 plans - not all will be available in every county - for Indiana residents on the federal exchange, she said. During the 2013-14 period, three companies offered 278 plans, The Times of Munster and the Post-Tribune reported.

“I think a lot of companies were waiting to see how the first year went,” Korty said. “Also were seeing some smaller providers that may offer a policy in only a few counties.”

Korty said a 5 percent average increase in exchange premiums is expected on Indiana policies.

Don't let the snarky headline fool you; I'm still very much a single-payer guy. However, anyone who still claims that the ACA exchanges are "socialized medicine" doesn't have the slightest clue what they're talking about. In case you needed even more proof that the ACA is very much private-market friendly:

Illinois:

After sitting out the first year, UnitedHealth Group Inc. intends to offer individual policies on the Illinois health insurance exchange next year, according to sources familiar with the company's plans.

The decision by UnitedHealth, the nation's largest and the state's No. 2 insurer, has the potential to shake up the Illinois market, which was dominated in 2014 by Blue Cross and Blue Shield of Illinois, the state's dominant insurer.

...United's participation also could help lower rates for consumers, a key concern among the law's supporters.

While United would neither confirm nor deny its plans to offer policies in Illinois next year, a spokesman said the Minnesota-based insurer intends to increase its participation over time in exchanges nationwide.

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