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I crunched the numbers for Texas, it's actually easier to figure out how many people would lose coverage if the ACA is repealed in non-expansion states because you can't rip away healthcare coverage from someone who you never provided it to in the first place.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.
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%.
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.
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.
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.
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.
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.
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.
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: