Things were looking pretty dicey for two of Montana's three insurance carriers participating on the individual market the past few days. One of the three, Blue Cross Blue Shield, saw the writing on the wall regarding Cost Sharing Reductions (CSR) likely being cut off and filed a hefty 23% rate hike request with the state insurance department. The other two, however (PacificSource and the Montana Health Co-Op, one of a handful of ACA-created cooperatives stll around, assumed that the CSR payments would still be around next year and only filed single-digit rate increases.
I'm not going to speculate as to the reasons why they both did so when it was patently obvious that having the CSRs cut off was a distinct possibility, although I seem to recall the CEO of the Montana Co-Op said something about their hands being tied since CSR reimbursement payments are legally required, after all. Basically, it sounds like he was genuinely trying to avoid passing on any more additional costs to their enrollees than they had to.
A shout-out to Jeremy Johnson for the heads up: The Montana Commissioner of Securities & Insurance has released their preliminary 2018 rate requests for the individual and small group markets...and it's pretty darned straightforward. As a nice bonus, they even saved me the trouble of digging up the effected enrollee numbers. In fact, the only critical data missing are the "Part II Justification" files, which hopefully clarify how the CSR payment/mandate enforcement situation plays into these requests.
Judging by the requests, it looks like at least 2 of the 3 on the individual market are assuming that CSR payments will continue and the mandate penalty will be enforced. As for the third (BCBSMT), they're asking for a 23.1% rate hike, so I honestly don't know whether that includes the TrumpTax or not. For the moment I'll assume it doesn't, but will change this later if I'm wrong about that.
Over the past few months, my Congressional District Breakdown tables estimating how many people would likely lose healthcare coverage if the ACA were to be "cleanly" repealed (with no replacement) have gotten a lot of attention. This was followed by the Center for American Progress (CAP) running their own estimates of how many would likely lose coverage if, instead of a "clean" repeal of the ACA as a whole, the ACA were to be partially left in place, with the GOP's AHCA (Trumpcare) bill, which dramatically changes the ACA, being signed into law instead.
In Montana, assuming 59,000 people enroll in private exchange policies by the end of January, I estimate around 39,000 of them would be forced off of their private policy upon an immediate-effect full ACA repeal, plus another 61,000 enrolled in the ACA Medicaid expansion program, for a total of 101,000 Montana residents kicked to the curb.
As for the individual market, my standard methodology applies:
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.
Lindeen Finds Blue Cross Rate Increases Unreasonable
HELENA – Montana Commissioner of Securities and Insurance Monica Lindeen announced today that following an extensive rate review process, her office has found the rates filed for health insurance in the individual and small-group marketplaces by Health Care Services Corp. (doing business as Blue Cross Blue Shield of Montana) to be unreasonable. This is the first time that such a finding has been issued.
Montana's entire individual market was around 70,000 people back in 2014, and has likely grown to around 87,000 today, so it looks like pretty much everyone is accounted for above (the remaining 9,000 or so are presumably enrolled in grandfathered policies; Montana is among the few red states which didn't allow transitional plans).
As for the actual requested rate hikes...ouch. BCBS is seeking a whopping 62% average increase, and since they own 70% of the individual market, that means a statewide weighted average of right around 50% even. Things aren't as ugly on the small group market, but that 27.5% average is still pretty ugly.
Regular readers may have noticed that I've been posting fairly lightly of late. Now that open enrollment is over and we're deep in the thick of primary season, I'm trying to catch up with the massive backlog which has built up in my day job.
However, there's still a lot of stuff going on; today, for instance, brought some very positive Medicaid expansion news out of two states:
Until this year, most of the ACA exchanges, including HealthCare.Gov, would simply report how many people selected QHPs through the exchange, whether paid up or not. There's nothing wrong with this as long as it's made clear at some point how many people actually paid their premiums and had their policies effectuated; the argument over this issue was the entire basis of the infamous "But how many have PAID???" fuss back in 2014. It was such a Big Deal that the Republicans on the House Energy & Commerce Committee even published the results on a laughably garbage-filled "survey" they had sent out to a portion of the insurance carriers.
Long-time readers may have noticed that unlike private QHP enrollment, I've sort of given up on trying to track Medicaid expansion numbers at the state-level on the Medicaid Spreadsheet this year. Quite frankly, there's simply too much missing data and way too much "churn" in Medicaid for me to keep track of it at that granular level. Instead, I've just been looking at the Medicaid numbers from the national level, guided by CMS's monthly reports...but I've proven to be pretty accurate with my proejctions on those trends so far, so I'm not too concerned about it.
HELENA, Mont. (AP) — Montana will become the 30th state to expand its Medicaid program after federal health officials on Monday approved provisions that include requiring beneficiaries to pay premiums that amount to 2 percent of their income.
Gov. Steve Bullock announced the Centers for Medicare and Medicaid Services' approval of the federal waiver needed for state officials to start enrollment this fall and begin coverage on Jan. 1.
The governor's office has said 70,000 people or more would be eligible for coverage under the expansion, but legislative fiscal analysts predicted about 45,700 would actually participate over the next four years.
Actually, if the past 2 years of Medicaid expansion in the other 29 states are any guide, Montana will probably hit 50-60K easily within the first year. Many other states ended up maxing out by the end of 2014.
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.