2018 MIDTERM ELECTION

Time: D H M S

Maine

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I crunched the numbers for Texas, it's actually easier to figure out how many people would lose coverage if the ACA is repealed in non-expansion states because you can't rip away healthcare coverage from someone who you never provided it to in the first place.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 Maine, assuming 86,000 people enroll in exchange policies by the end of January, I estimate around 61,000 of them would be forced off of their policy upon an immediate-effect full ACA repeal.

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.

I originally estimated Maine's 2017 avg. rate hike requests back in May. At the time, I came up with a weighted average of 20.7% based on the original rate filings:

Since then there have been two major changes: First, Aetna, which had been planning on entering the Maine ACA exchange, infamously pulled a complete 180 and not only decided not to expand, but actually pulled out of the exchange in most of the states they're already in. This doesn't really impact Maine since they were only available off-exchange anyway. The second change does, however: Several of the carriers submitted revised requests, pushing the average up higher, to 23.9%.

It turns out the various revisions were approved by the Maine dept. of insurance, mostly as is, although they did shave 1.4 points off of Anthem BCBS:

Just last week I ran the rate filing numbers for Maine and came up with an overall weighted 20.6% average hike request. Today I've learned three things:

Here's what it looks like with the revisions...the overall average barely changes at all, but it's still a more complete picture:

As numerous sources have already indicated, after 2 years of (relatively) low average premium rate increases on the individual market (around 5.6% in 2015 and 8.0% in 2016...compared with the 10-12% average rate hikes over the previous decade), it looks like 2017 will finally see the higher rate hikes that ACA critics have been screaming about every year.

So far, Virginia and Oregon have reported requested rate increases of 17.9% and 27.5% respectively, while California may be looking at 8.0% increases (which is high for them).

A couple of days ago I noted that after two years of nothing but doom & gloom (and coming just a week after UnitedHealthcare pulled the plug on the individual market in over two dozen states) there seems to finally be some positive developments, with companies like Centene and Anthem reporting better-than-expected results. They may not be making a profit yet, but at least they aren't losing money hand over fist the way they did the first couple of years.

I also made a brief mention of the Maryland Co-Op, Evergreen Health, which reported their first quarterly profit since launching 2 1/2 years ago.

Well, according to Adam Cancryn, Evergreen has been joined by at least two other positive Co-Op stories:

Consumer operated and oriented health plans in Maryland, New Mexico and Massachusetts will report profits in the first quarter, in a sign that some of the remaining Affordable Care Act-created nonprofits could be finding their footing on the state exchanges.

(sigh) OK, this one is not related to the Risk Corridor Massacre, since Community Health Options was actually profitable in 2014 and therefore never qualified for any RC payments anyway. Also, unlike the dozen ACA-created co-ops which are in the process of winding down operations by the end of the year, CHO is not going out of business, and in fact is remaining fully operational for 2016.

Having said that, this development is still a serious bummer given the carnage wreaked across the co-op landscape earlier this fall:

Maine's Community Health Options said Dec. 9 that it will cut short its sales of individual policies for 2016, in a sign that it is the latest Affordable Care Act-funded consumer operated and oriented plan to encounter financial difficulties.

I admit that given the carnage of the past couple of weeks, I'm almost afraid to post this entry...but I had to write something positive about the CO-OP situation.

With the ACA-created CO-OPs seemingly dropping like flies due to the #RiskCorridorMassacre, I thought this would be a good time to flip things around and look at which CO-OPs are doing well (or at least not badly).

This isn't much, but it'll do for now:

Wisconsin's insurance department says it has no intention of shutting down its #ACA co-op, which appears it will remain solvent next year.

— Bob Herman (@MHbherman) October 22, 2015

@charles_gaba and at this point, other than Maine, it's difficult to expect many others will last beyond risk corridors.

— Bob Herman (@MHbherman) October 22, 2015

This may seem a bit antlclimactic after today's big California news...unless you happen to live in Maine.

A big shout-out to Amy Fried for the heads up re. this story about Maine's 2016 rate requests:

Most Mainers buying Affordable Care Act insurance will see modest increases in their premiums for 2016, below the national average and much lower than the double-digit increases projected in some cities by a recent study of initial rate filings.

About 80 percent of the 75,000 Mainers purchasing ACA marketplace insurance have a plan through Lewiston-based Community Health Options – formerly Maine Community Health Options. The ACA marketplace, operated on the Web as healthcare.gov, is where those without insurance – often part-time or self-employed workers – can obtain subsidized benefits.

Over at Talking Points Memo, Amy Fried notes that something really, really stupid was just fixed in the state of Maine:

But LePage has also tried to take advantage of a wording error with the 2013 law funding energy efficiency programs. While lawmakers wanted $60 million spent to help homemakers use less energy heating their homes, the snafu would have reduced that to $22 million—less than half.

The text error in Maine involved just one word left out—"and." However, it wasn’t just the wording that mattered but also a decision from a body controlled by his appointees, the Maine Public Utility Commission, that ruled 2-1 that there would be far less money for efficiency projects than legislators wanted.

The error came down to this, according to the Portland Press Herald:

I don't post about the state of Maine very often, and given that their Governor is an utter nutbag that's usually a good thing. Tonight, however, I'm happy to report that at least 2 of the 34 states at risk of losing their federal tax credits in the event of a King v. Burwell plaintiff win next month are seriously prepping to "establish" a state-based exchange if need be (Pennsylvania is the other one):

In a unanimous vote, the Legislature’s Insurance and Financial Services Committee endorsed the effort to maintain the health insurance premium subsidies that are offered as tax credits through the Affordable Care Act. Those credits are being challenged in a federal lawsuit known as King v. Burwell, which the U.S. Supreme Court is expected to decide next month.

I'm kicking myself for not writing up a full post on this issue, since it's the issue which most directly connects today's election to ACASignups-specific issues, but thankfully, Sam Stein and Jeffrey Young have done a fantastic job anyway. The key takeaway is this:

There are two threads of conventional wisdom heading into Tuesday's midterm election. The first is that the election doesn't much matter. Regardless which party controls the Senate, President Barack Obama will still occupy the White House, which means gridlock will remain, if not escalate. The second is that, when it comes to Obamacare, the status quo will remain in place for at least the next two years. Senate Republicans may push for repeal votes. But Obama will veto them. Smaller reforms may pass. But the law will mostly remain intact.

There's been a lot of fuss made about 2015 ACA exchange premium rates not being available at Healthcare.Gov until after the election. The presumption, of course, is that this is being done for political reasons. While this may be true, it could also simply be that there's a lot of different policy figures to plug into the federal system, and some states haven't even finalized their rates yet.

That being said, residents of some states can check out the 2015 premiums now and compare them against their current premium:

IDAHO: Idaho is the only state moving from HC.gov to their own exchange. Idaho residents can check out their 2015 rates directly via the state exchange site.

CALIFORNIA: CoveredCA has 2015 rates available right now as well.

As with my recent Alabama post, in which BCBS of Alabama stated that they're seeing an 82% payment rate out of an 87% market share, this is not proof absolute for Maine, but it's the best guideline we have for the state at the moment: In yesterday's Congressional testimony, executives for Wellpoint, the 2nd largest insurer in the country, stated that 90% of their exchange QHP enrollments have been paid so far. I took a look at the states Wellpoint operates in; there's a good dozen or so, and their market share varies in each one, but there's one, Maine, where they had a whopping 74% market share last year.

OK, as noted a little earlier, I underestimated the February HHS Report for Exchange-based Private QHP enrollment by about 4.2%:

  • My Projection: 902,800 (4.202 million total)
  • Actual Enrollments: 942,833 (4.242 million total)

I'm perfectly happy to have underestimated. As for where the extra 40,000 enrollments came from, my initial guess would be that California, in particular, started ramping up their big March blitz a bit earlier and more successfully than I figured, which, again, I'm absolutely fine with. Update: Nope, actually, California's numbers plummetted in the 2nd half of Feb due to that ugly technical outage; see below for details.

I'm busily plugging the new enrollment numbers into the spreadsheet even as I type this, and will be updating with various notes and observations, so keep checking in.

OK, I've entered the QHP data; a couple of things to note:

Pages