2018 MIDTERM ELECTION

Time: D H M S

Michigan

Of the 31 states which have expanded Medicaid under the Affordable Care Act, only a handful issue regular monthly or weekly enrollment reports.

I noted in February that enrollment in the ACA's Medicaid expansion program had increased by around 35,000 people across just 4 states (LA, MI, MN & PA). By the end of March, the numbers in these 4 states had gone up by another 19,300.

It's the end of April now, so I checked in once more, and sure enough, the numbers continue to grow:

Of the 31 states which have expanded Medicaid under the Affordable Care Act, only a handful issue regular monthly or weekly enrollment reports.

Back on February 28th I noted that ACA Medicaid expansion enrollment across three states (Michigan, Louisiana and Pennsylvania) had grown by about 35,000 people since mid-January, to 667K, 406K and 716K people respectively.

Today, a month later, I decided to take another look at all three states, along with Minnesota (which I forgot to check last month). Sure enough, enrollment has continued to grow in all four, albeit at a slower pace:

Over the past month or so, I've been tallying up the number of people who would lose their healthcare coverage if and when the GOP actually does proceed with repealing the Affordable Care Act, breaking the totals out by both County and Congressional District in every state.

While this project has received high praise as a useful resource, one problem with it is that the numbers aren't static--between the high churn rate of the individual market and Medicaid, as well as the fact there's no limited enrollment period for Medicaid (you can sign up year-round), the enrollment figures are constantly changing.

Case in point: As of the beginning of January, roughly 640,000 Michiganders were enrolled in "Healthy Michigan", our name for ACA Medicaid expansion. By the end of January, that number had increased to just over 646,000.

 

For the most part, Republican Michigan Governor Rick Snyder has taken a fairly hands-off approach when it comes to both the Affordable Care Act and Donald Trump. He pushed for both Medicaid expansion and a state-based ACA exchange, but while he managed to get the former through the GOP-controlled state legislature (albeit 3 months late and with a few conservative trimmings), he failed on the latter front, and pretty much shrugged it off after that. Since then, Michigan's implementation of ACA Medicaid expansion has quietly been pretty damned successful, with 646,000 Michiganders (strike that...it's now up to 666,000!) enrolled in the program...over 6.5% of the entire state's population. Beyond that, however, Snyder has been fairly quiet about the ACA overall to my knowledge.

Regular readers (and Twitter followers) know that for the past month I've been heavily pushing my state-by-state analysis projecting how many people I expect to lose their healthcare coverage if/when the Republican-held Congress follows through on their promise to repeal the Affordable Care Act. As noted in that post and the various links within it, part of the projection is very specific and confirmed (ie, the exact number of Medicaid expansion enrollees), while the rest is more speculative. For one thing, I don't know exactly how many people will have enrolled in ACA exchange plans, because we're still in the middle of the open enrollment period; even then, the percentage of those enrollees who will be receiving APTC assistance is still unknown as well...and even then, not all of those folks will be receiving substantial subsidy assistance which would make or break their ability to keep their policy.

Right on top of Pennsylvania, the Michigan Dept. of Insurance has issued their final approvals for 2017 individual and small group market rate increases. As has been pretty typical this year, the final approved rates aren't all that different from what was requested; a little nip/tuck here and there, and the 17.2% average requested has been slightly trimmed to 16.7% approved for the indy market. Meanwhile, the small group average is barely noticeable: 2.6% requested, 2.5% approved. Unlike most states, the MI DOI has already done most of the heavy lifting for me, so I don't even have to use my own spreadsheet to calculate the weighted average.

Priority Health and Health Alliance Plan (HAP) is joining the "HMO only" crowd here in Michigan:

Following announcements by for-profit commercial carriers Humana and United Healthcare, nonprofits Health Alliance Plan and Priority Health are notifying agents they are pulling all PPO plans for 2017 from the Michigan health insurance exchange, Crain's has learned.

HAP has already announced it is pulling eight Personal Alliance individual preferred provider plans for individuals from the exchange and four PPO plans in the open market next year. HAP will continue to offer HMO individual plans on and off the exchange.

"We believe that these (PPO) plans do not represent the best value for the consumer," said Mary Ann Tournoux, HAP's senior vice president and chief marketing officer, in a statement. "At this time of cost-consciousness, we believe our remaining plans are the most cost-effective and offer our members and consumers greater value for their hard-earned insurance dollar."

Today is August 1st. I was hoping that most/all of the states still missing from my 2017 Requested Rate Hike project would finally make their rate filings public as of today, but apparently not (or at least, they aren't live as of 10am).

However, there's one rate request story this A.M....about Michigan, from my local paper, the Detroit Free Press:

Health plans sold on Michigan's insurance exchange could see an average 17.3% increase next year, and if recent history is any guide, state regulators could approve the insurance companies' rate hike requests without many — if any — changes.

The rate increases would mean a financial hit for taxpayers in general and the 345,000 Michiganders who buy their health insurance on the Healthcare.gov exchange, created under the Affordable Care Act, also known as Obamacare.

OK, regular readers know that I almost never write directly about Medicare-related issues (unless it's in relation to trying to figure out the total uninsured rate and so forth), and I've only even mentioned Medigap before 3 times in the history of this website. I honestly don't know much about the program except that it's basically supplemental insurance which covers treatment/services not already covered by Medicare.

However, this seems like a significant development for my home state:

Seniors can expect to pay an additional $48 to $177 per month on BCBS Medigap plans.

Nearly 200,000 seniors can expect to pay more for their Medigap supplemental health insurance plans next year -- for some older individuals, more than twice their current amount -- when Blue Cross Blue Shield of Michigan goes forward with a long-awaited rate increase that does away with what the insurer says are below-market rates.

Blue Cross today proposed the new Medigap rates that would take effect on Jan. 1, following a five-year rate freeze for its Legacy Medigap plan.

My home state of Michigan has finally published the "Part II - Consumer Justification Narrative" carrier filings for 14 of the 15 carriers offering individual market plans next year. The combined total number of current enrollees comes in at around 390,000 including both on and off-exchange numbers. Last year, Michigan had 560,000 people on the ACA-compliant individual market, so it's important to note that there's likely at least 170,000 people missing from this analysis. However, many of these are likely found here:

  • UnitedHealthcare is pulling out of the MI market (unknown number of enrollees)
  • Humana is dropping their PPO offerings only (1,717 enrollees, included in table)
  • Celtic, Consumer's Mutual, HealthPlus and Time Insurance are all long gone
  • While I have the data for "Priority Health Plan", their counterpart, "Priority Health Insurance Co." has an unknown number of additional enrollees...and an unknown rate hike request (I don't know if it just hasn't been added to the database yet or what).

It should be noted, however, that last year, "Priority Health Insurance Co." had only about 1/10th as many enrollees as "Priority Health". If that ratio holds up this year, that should only be around 9,000 people, which is unlikely to skew the statewide average up or down by much.

With that in mind, here's how the requested hikes shake out in the Wolverine state for the bulk of indy market enrollees next year:

UPDATE: It turns out that Humana is not dropping out of Michigan entirely; they're only dropping their PPO plans, not their HMOs.

I noted last month that like UnitedHealthcare, Humana is pulling out of the individual market in multiple states next year. Unlike United, however, both the number of states and the number of enrollees impacted by Humana's withdrawl is fairly nominal; at the time I counted 5 states and around 25,000 total enrollees. Since then, Humana has confirmed that they're also dropping out of Colorado (9,914 enrollees), for a total of roughly 35,400 people nationally.

Today, I've confirmed that Michigan can be added to the list, impacting 1,717 people enrolled in off-exchange PPO plans. This brings the total to around 37,000 nationally:

Hmmmm...I'm still waiting for the Michigan Dept. of Insurance to publicly post the 2017 requested rate hikes (they aren't due until June 20th, apparently), but in the meantime, Blue Cross Blue Shield of Michigan (the largest insurer in the state) decided to issue a press release patting themselves on the back for keeping their small business average rate hike down to 2.9%:

DETROIT, June 8, 2016 /PRNewswire-USNewswire/ -- In contrast to national trends, Blue Cross Blue Shield of Michigan today announced a comparatively small statewide average rate increase of 2.9 percent for small group employers in 2017, pending state regulatory approval. This follows rate reductions that Blue Cross delivered to small employer group customers that renewed during the second half of 2015.

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:

After a year and a half of allowing the residents of Flint, Michigan to be poisoned, GOP Governor Rick Snyder, in response to growing public pressure, finally decided to do something decent for once:

Gov. Rick Snyder said Tuesday he will seek permission from the Obama administration to allow all young people in Flint the chance to receive publicly funded health care services for lead exposure amid the city's contaminated drinking water crisis.

...The White House and federal Department of Health and Human Services did not have an immediate response Tuesday to Snyder's initiative targeting Flint residents up to age 21 through the expansion of Medicaid.

Even then, he wasn't exactly in a big hurry to do so; he waited another 3 weeks to get around to actually submitting his request:

Over the past week or so, UnitedHealthcare started making good on their threat last fall to drop out of the ACA exchanges in at least some of the 33 states that they offer individual market policies in. On April 8th they said they were pulling up stakes in Arkansas and Georgia (although they're keeping a small presence in Atlanta via their experimental "Harken Health" division). Then, last Friday, they said they were dropping off the Michigan exchange as well...and just today, Adam Cancryn noted that they're pulling the plug on Oklahoma, while Zachary Tracer says they're pulling out of Louisiana. Ugh.

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