Missouri

Five states held their primary elections for non-Presidential races yesterday, including Missouri...and Missouri also had another important measure on the statewide ballot:

On Tuesday, August 4, all Missourians will have the chance to vote Yes On 2 to bring more than a billion of our tax dollars home from Washington every year – money that’s now going to places like California and New York instead.

By bringing our tax dollars home, we can protect thousands of frontline healthcare jobs, help keep rural hospitals open, and deliver healthcare to Missourians who earn less than $18,000 a year. That includes thousands of veterans and their families, those nearing retirement, working women who don’t have access to preventive care, and other hardworking Missourians whose jobs don’t provide health insurance.

When I first read the quote, I assumed it was either a paraphrase, out of context or sarcasm. Sadly, it was none of those:

A series of controversial remarks by Missouri Gov. Mike Parson on a St. Louis radio show are getting widespread attention — and some pushback.

In an interview on Friday with talk-radio host Marc Cox on KFTK (97.1 FM), Parson indicated both certainty and acceptance that the coronavirus will spread among children when they return to school this fall. The virus has killed 1,130 people in the state despite a weekslong stay-at-home order in the spring that helped slow the virus’ spread — and the state set a record on Saturday with 958 new cases.

...Parson’s comment on the coronavirus signaled that the decision to send all children back to school would be justified even in a scenario in which all of them became infected with the coronavirus.

Back in 2018, I was all over the trend of deep red states putting ACA Medicaid expansion on the ballot after getting fed up with years of their elected leaders refusing to do so. Idaho, Utah and Nebraska voters all did exactly that, passing it by solid margins. Unfortunately, state Republicans got in the way (or at least tried to) in all three states, adding hurdles, barriers and caveats which have either delayed or partly weakened them.

Nonetheless, Utah and Idaho have both implemented Medicaid expansion to low-income residents (and thank God, given the current ongoing COVID-19 pandemic), while as far as I can tell, Nebraska is scheduled to launch their expansion program (called "Heritage Health") starting this October.

The recent elections in Virginia, Kentucky and Louisiana had two things in common: The first is that all three were huge victories for Democrats (they took control of both the state House and Senate in Virginia, flipped the Governor's seat in Kentucky and held onto it in deep red Louisiana).

The second is that all three elections were won in large part based on...Medicaid expansion.

As Greg Sargent notes in the Washington Post:

Yet Edwards won, in large part, by also stressing his implementation of the Affordable Care Act’s Medicaid expansion in the state during his first term. Indeed, Edwards’s lead pollster, Zac McCrary, told me during an interview that no single issue was more important in driving the governor’s victory.

Missouri's final/approved avg. 2020 unsubsidized premium rate changes have finally been posted by CMS. For the most part they're following the same pattern as most other states this year with modest increases or decreases and a statewide weighted average decrease of 2.0% year over year. On average, unsubsidized ACA enrollees should pay about $13/month less next year than they are today.

However, what is noteworthy is that not one, not two but three new insurance carriers are entering the MO individual market this fall, bringing the total up to seven operating statewide: Cox Health Systems, Oscar Insurance (which was cofounded by Jared Kushner's brother, FWIW) and SSM Health Insurance.

MLR rebate payments for 2018 are being sent out to enrollees even as I type this. The data for 2018 MLR rebates won't be officially posted for another month or so, but I've managed to acquire it early, and after a lot of number-crunching the data, I've recompiled it into an easy-to-read format.

But that's not all! In addition to the actual 2018 MLR rebates, I've gone one step further and have taken an early crack at trying to figure out what 2019 MLR rebates might end up looking like next year (for the Individual Market only). In order to do this, I had to make several very large assumptions:

via Crystal Thomas of the Kansas City Star:

Groups hoping to make Missouri the 37th state to expand Medicaid officially launched a campaign Wednesday to put the question on 2020 ballot.

In Missouri, the state-run Medicaid program, MO HealthNet, provides health insurance only to children, pregnant women, those with disabilities and some seniors.

Expansion could mean coverage for an additional 200,000 Missourians under the proposal, according to Healthcare for Missouri, the campaign committee leading expansion efforts.

The committee was formed in March and spent the summer exploring whether expansion was possible in Missouri through initiative petition. On Wednesday, it announced it would commit to putting the question in front of voters in 2020.

...the campaign includes supporters like the Missouri Hospital Association, the Missouri Primary Care Association and a similarly named permanent advocacy group, Missouri Health Care for All.

Missouri has also released their preliminary 2020 Individual and Small Group market premium rate change filings. For the most part they're following the same pattern as most other states this year with modest increases or decreases and a statewide weighted average decrease of 1.8% year over year. On average, unsubsidized ACA enrollees should pay about $11/month less next year than they are today.

However, what is noteworthy is that not one, not two but three new insurance carriers are entering the MO individual market this fall, bringing the total up to seven operating statewide: Cox Health Systems, Oscar Insurance (which was cofounded by Jared Kushner's brother, FWIW) and SSM Health Insurance.

The Small Group market, meanwhile, is looking at roughly 6.9% premium increases, although this could be a bit off since I had to use the 2018 enrollment number for UnitedHealthcare, which also happens to have the largest market share of the six companies in that market:

I realize this may seem a bit late in the game seeing how the 2019 ACA Open Enrollment Period has already started, but I do like to be as complete and thorough as possible, and there were still 9 states missing final/approved premium rate change analyses as of yesterday which I wanted to check off my 2019 Rate Hike Project list.

Fortunately, RateReview.HealthCare.Gov has finally updated their database to include the approved rate changes for every state, which made it easy to take care of most of these. In addition, in a few states the insurance department has also posted their own final/approved rate summary.

The Missouri Insurance Dept. has released preliminary 2019 rate filings for the individual and small group markets. Interestingly, in addition to the ACA compliant rate changes, they also posted transitional policy rate changes as well, which is unusual.

Missouri's situation is pretty straightforward: Three existing ACA market carriers are sticking around, and a fourth one is jumping in (Medica). Since Medica is new to the market, they don't have any actual rate changes to speak of. The other three are requesting rate increases of 3.7%, 7.3% and -8.6% respectively; Celtic is dropping rates next year.

With only 5 days to go before the launch of the 2018 Open Enrollment Period, time is rapidly running out for me to wrap up my 2018 Rate Hike Project. I started this, as I have for 3 years now, back in late early May with the very first requested rate changes out of Virginia, and have been tracking all 50 states as the summer and fall have passed, following every twist and turn of the insane repeal/replace circus in Congress, Trump's bloviating and blathering about "blowing things up" and "letting Obamacare explode", the last-ditch "Graham-Cassidy" sideshow and everything else, right up to and through Trump lowering the boom on cutting off CSR reimbursement payments.

Thanks to Zach Tracer for the heads up!

My 2018 Rate Hike project petered out a few weeks back with the requested rate increases posted for 46 out of 50 states (along with DC). Unfortunately, the last 4 states (Kansas, Missouri, Nevada and Utah) decided to keep their cards close to their chest, delaying any public viewing of even the requested rate increases for awhile longer.

Between updating the "Who could lose coverage" graphics, prepping for my town hall thing last night and updating the 2018 Rate Hike project, I've gotten way behind on my "Who's saying 'screw rate hikes, I'm just gonna bail completely next year' updates. Let's take care of that now, OK? The first three updates are courtesy of Louise Norris writing for healthinsurance.org; the fourth is vai Kimberly Leonard for the Washington Examiner:

IDAHO: BridgeSpan is out, 4 carriers staying put:

Insurers in Idaho had to submit forms for 2018 plans by May 15, but they have until June 2 to file rates. Mountain Health CO-OP, SelectHealth, PacificSource and Blue Cross of Idaho all filed forms to continue to offer Your Health Idaho plans in 2018.

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:

Last week I noted that with 41 states accounted for and the 2017 Open Enrollment Period quickly bearing down on everyone, it was time to pull the plug on my 2017 Average Rate Hike project and move on. I had come up with an overall national weighted unsubsidized average rate increase of around 25% for ACA-compliant individual market plans.

However, I also noted that I'd make sure to fill in the approved rates for the remaining 10 states as they came in, for completeness sake...and today, thanks to the HHS Dept. cutting the ribbon on 2017 Window Shopping at HealthCare.Gov, I've also been able to fill in the blanks for five of the remaining states all in one shot (the other five remain elusive).

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