Montana

2018 MIDTERM ELECTION

Time: D H M S

I posted Montana's preliminary/requested 2019 ACA indiividual market rate change requests back in late June. At the time, they were seeking average rate increases of 6.0% statewide, and I estimated that the GOP's repeal of the ACA's individual mandate penalty, combined with the Trump Administration's expansion of #ShortAssPlans, accounted for about 9.9 percentage points of that.

More recently, the state insurance commissioner's website published approved 2019 rate changes. The average increases have been sliced down slightly (from 6.0% to 5.7% on average), and I've lowered my estimate of #ACASabotage impact from 9.9% to 6% based on the lack of either factor being prominently mentioned in the actual carrier rate filings. If accurate that means rates would have been flat year over year on average in 2019 if not for those factors.

Unsubsidized Montana enrollees are paying an average of $637/month this year, so that's roughly a $38/month difference, or around $460 for the full year.

I received a tip about this early this morning...which, unfortunately, I was unable to scoop anyone with due to being bogged down/caught up with the #TexasFoldEm drama.

As a result, it looks like Shelby Livingston of Modern Healthcare was first to post about it:

Montana insurer wins lawsuit against feds over unpaid cost-sharing reduction payments

Several health insurers have sued the U.S. government over its failure to make cost-sharing reduction payments that help lower healthcare costs for certain consumers. One just scored the first victory. The U.S. Court of Federal Claims ruled in favor of Montana Health Co-op, which sued the federal government for $5.3 million in unpaid cost-sharing reduction payments, finding that the government violated its obligation under the Affordable Care Act when it stopped paying the CSRs in October 2017."

The rest of the article is behind a paywall, but the gist of it is as follows:

This article from KTVQ is excellent for my purposes. It clearly and cleanly plugs in just about all of the hard numbers I need to run my rate hike analysis: Which carriers are participating in the 2019 ACA individual market; how many current enrollees each carrier has (both on and off the exchange); and the exact average increase each one is requesting for next year!

Health insurers selling individual policies on the “Obamacare” marketplace in Montana are proposing only modest increases for 2019, on average – or, no increase at all.

State Insurance Commissioner Matt Rosendale released the proposed rates Thursday, with Blue Cross and Blue Shield of Montana proposing an average increase of zero – and a 4.9 percent decline for small-group policies.

The other two companies selling policies on the online marketplace, PacificSource and the Montana Health Co-op, proposed average increases of 6.2 percent and 10.6 percent for individual policies, respectively, and lesser increases for small-group policies.

As long as I'm focusing on Medicaid expansion news (and since I write about Montana pretty rarely), here's a mildly interesting tidbit:

Last June I noted that ACA Medicaid expansion in Montana had increased dramatically in a year and a half, from 47,000 in early 2016 to over 77,000 enrollees as of May 2017.

According to this article, they're now up to 91,000:

HELENA — There are 91,563 Montanans participating in the Medicaid expansion HELP act as of Jan. 15, generating nearly $40 million in savings in Medicaid benefits, a state panel was told Thursday.

Members of the Legislature’s Children, Families, Health and Human Services Interim Committee reviewed a report on Medicaid expansion. The committee took no immediate action after hearing the report.

Me, just under a month ago:

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.

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.

Once upon a time there were 23 health insurance cooperatives created via ACA provisions, spread across a similar number of states (a few operated in more than one, while some states had more than one co-op operating within it).

The first one to fall was CoOportunity, which operated in Iowa and Nebraska. Their enrollments were halted in the middle of the 2nd Open Enrollment period, and they were liquidated before OE2 even finished.

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.

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).

It's early June now, so I checked in once more, and the numbers have continued to grow. I have the direct links for 5 states now (including New Hampshire)...

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.

Between ConnectiCare in Connecticut, Centene in Arizona and now this, these last-minute changes are giving me ulcers trying to keep up...

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.

It's been several weeks since the most recent state was added to my 2017 requested rate change project (Michigan, with a weighted average of 17.2%). There are 15 states remaining...or rather 14 now, because Montana has finally posted their filings for 2017. Here's what the requested changes look like:

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:

New Hampshire House passes Medicaid reauthorization

The New Hampshire House on Wednesday approved legislation that would keep 48,000 people on their insurance plans by continuing the state's expanded Medicaid program beyond the end of the year.

The bill, which now goes to the Senate, includes work requirements for recipients and asks insurance companies and hospitals to cover the state's share of the program's costs.

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