Iowa

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.

Thanks to commenter "InTheKnow" for the heads up:

Wellmark Blue Cross and Blue Shield announced Tuesday that it will narrow its choices for individual Affordable Care Act plans in Iowa and will eliminate ACA individual plans in South Dakota altogether in 2017.

First, some clarification: Wellmark isn't on the exchange to begin with, and wasn't planning on joining it in SD next year, so this is a rare case of a carrier dropping their off-exchange individual market offerings. Since all of Wellmark's indy enrollees in South Dakota are paying full price, this one can't be blamed on APTC enrollees being sicker than average, etc.

Having said that, this does impact around 8,000 off-exchange enrollees in SD.

As for Iowa, it's more of a mixed bag...Wellmark is basically swapping out higher end PPO plans for lower end HMO, which is pretty much the trend everywhere:

Thanks again to contributor "M E" for the link to this Des Moines Register article, which lists most of the approved 2017 individual market rate hikes:

More than 75,000 Iowans will see their insurance premiums rise next year.

Iowa Insurance Commissioner Nick Gerhart has approved rate increases sought by four companies who provide health insurance in the state, Gerhart's agency announced Monday. The increases include plans covered by Wellmark Blue Cross & Blue Shield, the state's dominant health insurer.

However, the article was a little vague about some of the data, so I visited the IA DOI website and sure enough, they have separate entries for every one of the carriers (with one exception):

The dominant carrier on the individual market in Iowa is Wellmark BCBS, which had 137,000 enrollees (something like 75% of all the market) last year.

However, there were two important caveats to that: First, Wellmark isn't currently participating on the ACA exchange; all of those enrollees were off-exchange only. Secondly, at the time I had no idea how many of them were ACA-compliant and how many were "grandfathered" or "transitional" policies, which aren't ACA compliant and which, more significantly, aren't part of the same risk pool.

Well, Wellmark just announced that they will finally be jumping onto HealthCare.Gov for 2017. This is great news, not just because they're the dominant carrier in the state but also because it'll help fill the hole created by UnitedHealthcare dropping out.

HOWEVER, I suspect that today's news may also help explain their reasoning (I'll get to that later):

When UnitedHealthcare announced last month that they were making good on their threat last fall to pull out of the individual market in over two dozen states next year, it caused shockwaves across the health insurance industry. It is an important development, as around 800,000 people will be impacted.

When Humana announced last week that they plan on pulling out of the individual market in at least 5 states next year, it was interesting and a bit of a bummer, but not nearly as earthshattering, because only about 25,000 people will have to shop around and find a new carrier.

Today, it is my duty to announce that Celtic insurance has also decided to pull out of the entire individual insurance market (both on and off-exchange) across at least 6 states, including:

The UnitedHealthcare Dropout Odometer grew by two more states today, as both Kentucky and Iowa were scratched off the "2017 Exchange Participation" list.

However, there's some positive news for Iowa, at least; as noted by Cynthia Cox and reported on by Tony Leys of the Des Moines Register, Wellmark is joining the Iowa exchange next year:

Iowa’s dominant health insurer has agreed to start selling policies a year from now that qualify for Obamacare subsidies.

Wellmark Blue Cross & Blue Shield has not participated in the Affordable Care Act’s online health insurance marketplace, which launched in the fall of 2013. The main effect of the company’s decision was that moderate-income Iowans could not choose Wellmark insurance if they wanted to purchase policies that qualified for new federal subsidies to help pay premiums.

Over at Forbes, virulently anti-ACA critics Josh Archambault and Jonathan Ingram have written a detailed analysis of What Went Wrong with Iowa's implementation of the Affordable Care Act's Medicaid expansion provision. While their tone is understandably hostile, from what I know of the situation, it seems to check out for the most part (granted, the only part of this piece I knew much about until now was the CoOportunity failure portion of it).

First, it's important to understand that Arkansas is not the only state which has been using a "private option" solution for their ACA Medicaid expansion program; Iowa opted for this as well. For some reason, Arkansas is the only state ever mentioned when this comes up, probably because they were the first ones to do so, I believe:

Iowa’s expansion was loosely modeled afterArkansas’ Obamacare expansion. Under Iowa’s “Marketplace Choice” waiver, able-bodied adults above the poverty line would receive Medicaid benefits through Obamacare exchange plans.

This article in the Des Moines Register seems to be fairly clear, but there's some weird discrepancies which make me wonder, so take this with a grain of salt:

Iowa's chief insurance regulator has approved double-digit premium rate increases affecting thousands of Iowans.

The Iowa Insurance Division said Wednesday that Insurance Commissioner Nick Gerhart has approved increases requested by Wellmark Blue Cross & Blue Shield, Coventry Health Care and Gundersen Health Insurance.

All of the rate increases are for policyholders holding individual health insurance plans. They will go into effect Jan. 1.

This is an incredibly depressing post for me to write. Last month I received word that CoOportunity Health, one of the 23 co-ops set up as part of the ACA to offer competition with the Big Boys, had run into serious financial trouble and was being yanked off of Healthcare.Gov (they were operating in Iowa and Nebraska, both of which are on the federal exchange).

This surprised me because from everything I had heard, CoOportunity was doing quite well, with upwards of 120,000 QHP enrollees last year. I've written about them several times in the past, and have kind of a special fondness for them because they were one of the first sources I had for solid OFF-exchange QHP enrollment data.

Anyway, as of December 10th, my contact at CoOportunity was unaware of any issues; they reported that everything was going great. On Christmas Eve, I was tipped off about CMS dropping CoOportunity from the exchange completely, but there wasn't a whole lot of detail given as to what had gone wrong beyond vague references to quarterly financial statements, cash flow and annual audits.

WASHINGTON: Health Exchange leaders are trying to solve the problems from the first sign-up period

CLARKSTON, WA – Leaders with Washington’s Health Care Exchange are preparing for the second open enrollment period, but at the same time they are still working on resolving billing and computer problems for 1,300 accounts from the first sign-up period.

IOWA: Three health insurers get OK to increase rates

This is very confusingly worded, because it makes it sound like all 3 companies have been operating on the HC.gov exchange when it turns out that only 2 of them have. Wellmark did not participate in the ACA exchange; the 19,000 customers referred to here have off-exchange policies which are still ACA-compliant:

Commissioner Nick Gerhart said today that he has approved premium increases from Wellmark Blue Cross and Blue Shield, CoOportunity Health and Coventry Health.

Not exactly the most shocking headline, I know.

Around 26,000 Iowans are privately insured via the ACA exchange (assuming the standard 90% paid their first month's premium) , plus another 80K - 100K via Medicaid expansion.

Naturally, Joni "hog castrator" Ernst had bupkes:

 A query from a viewer said he had received health coverage through the Affordable Care Act. To Ernst, he asked, "Have you given any thought to how individuals in my situation won't lose coverage, should repeal occur?"

Ernst called Obamacare a "job killer" in Iowa that is "taking personal health decisions out of our hands and placing them with nameless, faceless bureaucrats in Washington, DC." That is to some degree true, but what about the guy's question? It was a reasonable concern; millions of people are now receiving subsidies to purchase health insurance. If Republicans repeal Obamacare, what happens to them?

GAH!! That's three "solid numbers but vague definitions attached to them" articles in a row this evening:

Braley also used the debate as an opportunity to show that he has worked with Republicans such as Iowa Gov. Terry Branstad. The two worked together to expand Medicaid, giving more than 80,000 people health coverage who didn’t have it before. 

OK, that makes it sound like 80K newly added to Medicaid via ACA expansion. However, in an earlier Iowa update, it made it sound like IA has some sort of Arkansas-like "private option" thing going on which had 20,000 enrolled at that time. So...is the 80K referred to above in addition to those 20K, or are they included in it?

(sigh) Again, not sure how to handle this. Anyone familiar with the Iowa Medicaid situation, please feel free to chime in below. Either way, it sounds like I can safely bump Iowa's "strict expansion" tally up from 20K to at least 80K, anyway...

Well, well, well; imagine that...

While Obamacare attacks continue to fade, health reform’s success is even forcing some Republicans to acknowledge the law is having positive effects.

The latest example comes from Iowa’s third congressional district, where David Young (R) is facing former state Sen.Staci Appel (D) to replace retiring-Rep. Tom Latham (R-IA) in a toss-up seat.

...BORG: Did you favor the expansion of Medicaid, which was included in Obamacare?

YOUNG: It seems to be working in Iowa. I would make sure in any regards to Medicaid they would have some kind of flexibility.

...Still, Young was asked twice by Borg whether he would support repealing Obamacare, as has been the Republican mantra for the past four years. Both times, Young refused to say he wanted to do so.

My in box is once again flooded with ACA-related stories which are interesting but which I just don't have time to do full write-ups on...

ILLINOIS: Clock Ticking For Illinois To Form State-Run Obamacare Exchange

Unless Illinois acts quickly, it will leave hundreds of millions of federal dollars on the table that would go toward building its own health insurance marketplace, potentially upping the cost of coverage for nearly 170,000 Illinois residents. State lawmakers, unable to break a years-long standoff, have not passed a law authorizing a state-based exchange, the marketplaces created under the Affordable Care Act that allow consumers to compare and buy health coverage, often with the help of federal tax credits. As a result, Illinois was one of 36 states that relied on the federal government to host its marketplace on HealthCare.gov, the website that survived a disastrous launch late last year to enroll about 217,000 Illinoisans, 77 percent of whom received federal help.

My in box is once again flooded with ACA-related stories which are interesting but which I just don't have time to do full write-ups on...

Joe Sonka has an excellent (if depressing) analysis explaining why Kentucky Senate candidate Alison Lundergan Grimes isn't campaigning on the Affordable Care Act even though her opponent, Mitch McConnell, has done everything he can to tear away healthcare from a half-million Kentuckians:

The reasons for this disconnect are many and are closely tied to the decision of Alison Lundergan Grimes’ campaign to steer clear of the issue. But this decision by Grimes to avoid talking about the benefits of health care reform is not just an effect of the disconnect, it is also a cause of the disconnect, itself.

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