This isn't the biggest development in the world, but exactly a year ago today I made a big fuss about how New Jersey (and DC) had reinstated their own health insurance individual mandate penalties after the federal version was zeroed out by Congressional Republicans...but didn't seem to be going through much effort to let people know about the penalty.
While Massachusetts had launched a massive multi-media awareness/education blitz statewide to make sure people knew that they had dusted off their pre-ACA coverage mandate requirement, New Jersey and DC didn't appear to be doing much, if anything, to let people know that they'd face a stiff tax penalty if they didn't either #GetCovered or qualify for an exemption.
As I noted at the time, just like the Doomsday Device in Dr. Strangelove, it completely defeats the whole point of having a penalty if no one knows it exists.
Governor Murphy and New Jersey Department of Banking and Insurance Kick Off ACA Open Enrollment Period
Governor Announces Strengthened ACA Efforts, including $3.1 Million to Support Outreach and Enrollment Efforts and Bolstered Get Covered NJ Awareness Campaign
TRENTON – Governor Phil Murphy, joined by Department of Banking and Insurance (DOBI) Commissioner Marlene Caride and enrollment assisters from across the state, today announced Navigator grant awards totaling $1.1 million to provide enrollment assistance to residents shopping for health coverage during the six-week open enrollment window. DOBI plans to release approximately $500,000 more in grants in the coming days.
This Just In, via the New Jersey Dept. of Banking & Insurance...
NJ Department of Banking and Insurance Releases Health Plan Rates
On Average, NJ Individual Market Rates for 2020 Remain 1.4% Lower Than 2018
The New Jersey Department of Banking and Insurance today released rates for health insurance plans in the individual market effective January 1, 2020. On average, rates for 2020 will remain 1.4 percent lower than they were in 2018, due to policy actions taken by the Murphy Administration to stabilize the insurance market.
OK, hold up, read that again: 1.4% lower than 2018 premiums, not 1.4% lower than 2019. That's kind of an important distinction. Don't get me wrong, this isn't a bad thing to note, but it's not that impressive considering some other states are seeing rate reductions from 2018. Of course, there's a lot of factors at play which vary from state to state as well.
*(Yes, I know, the District of Columbia isn't actually a state, and Vermont's mandate is...well, read on...)
As the 2020 Open Enrollment Period rapidly approaches (it starts November 1st nationwide...except for California, where open enrollment is starting on October 15th), it's time to start getting the word out about some important things to keep in mind this fall.
One of the most critical things to remember for residents of California, the District of Columbia, Massachusetts, New Jersey, Rhode Island and Vermont is that each of these states* has reinstated an individual healthcare coverage mandate law/ordinance to replace the federal ACA mandate penalty which was zeroed out by Congressional Republicans back in December 2017. This means that if you live one one of them, unless you receive an affordability, hardship or other type of acceptable exemption, you'll be charged a financial penalty when you file your state/district taxes for 2020 in spring 2021 if you don't have qualifying healthcare coverage.
One of the interesting quirks of how the Affordable Care Act's enhancement of our crazy patchwork heatlhcare system works is that there's something of a zero-sum game when it comes to enrollment numbers.
For instance, Virginia's ACA exchange enrollment numbers dropped by 18% this year, from 400,000 to 328,000, due primarily to the state finally getting around to expanding Medicaid to enrollees earning less than 138% of the Federal Poverty Level. Since people earning between 100-400% FPL are eligible for ACA subsidies if they enroll through the exchange, that means there's an overlap for those in the 100-138% range which these folks fell into. The same thing happened in Louisiana, even more dramatically, after they expanded Medicaid halfway through 2016...the following year exchange enrollment dropped by 33%.
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:
First, I've assumed that total enrollment for each carrier remains exactly the same year over year.
Second, I've assumed that the average 2019 rate changes I recorded for each carrier last fall are accurate.
Third, I'm assuming that 2019 is seeing a 5% medical trendline on average...that is, that total 2019 claims per enrollee will be 5% higher than 2018's.
All three of these are very questionable, of course, but they at least provide a baseline.
New Jersey is an important state to watch, as they (along with DC) are the first state to specifically reinstate the ACA individual mandate penalty at the exact same levels as the just-zeroed out federal version. Massachusetts has a mandate penalty in place this year as well, but a) theirs pre-dated the ACA and was simply dusted off again and b) theirs uses a different formula anyway.
Last year, Individual Market insurance carriers in New Jersey announced that average unsubsidized 2019 premiums would be reduced by an average of 9.3% statewide due to two laws put into place by the state legislature and Governor Murphy: Reinstatement of the mandate penalty at federal levels (which lowered rates by 6.8 percentage points from +12.6% to just +5.8%) and the initiation of a solid reinsurance waiver program (which reduced rates by a further 15.1 points, for a final average change of -9.3%).
New Jersey’s most powerful state lawmaker said he will delay a vote to create the state’s own online shopping portal for health insurance, one of Gov. Phil Murphy’s priorities intended to guard against the possible repeal of the Affordable Care Act.
The delay means the state won’t meet an Aug. 1 deadline to submit an application to the federal government to create the exchange. The anticipated launch of a Fall 2020 open enrollment period would have to be postponed until 2021, a group of health policy experts warned.
State Senate President Stephen Sweeney, D-Gloucester issued a statement Tuesday affirming his support for creating New Jersey’s own health exchange. Sweeney said he just disagrees with the way fellow lawmakers want to go about it because it doesn’t include a means to automatically enroll low-income people into the Medicaid program.
Last year, I noted several times that regardless of what your opinion may be of the ACA's Individual Mandate Penalty (which was, until this year, either $695 per adult/$348 per child or 2.5% of your household income, unless you received an exemption), one of the key things to keep in mind about the penalty is that any impact it has on encouraging people to go ahead and enroll in ACA-compliant healthcare coverage is entirely dependent on two things:
Democratic lawmakers introduced a dozen bills late last week to create the infrastructure, funding, and regulatory structure for a state-based system that would enable New Jersey officials to create, market, and sell health insurance policies to low-income individuals and small businesses with fewer than 50 employees.
This one came completely out of left field, but it's a pleasant surprise.
Last year, New Jersey Governor Phil Murphy, along with the Democratically-controlled state legislature, passed several sweeping laws and policies designed to either protect the ACA from sabogate efforts by the Trump Administration or to cancel out existing sabotage measures.
Last night, in response to CMS Administrator Seema Verma taking shots at both Covered California (for blaming their drop in new enrollment on the federal mandate being repealed) and New Jersey (for seeing a 7.1% exchange enrollment drop in spite of reinstating the mandate), I wrote a long analysis which noted that:
Verma may have a valid point, but...
There's not nearly enough data available to know one way or the other (especially the missing off-exchange data for this year), and...
Even if she turns out to be correct about NJ's total enrollment drop, NJ reinstating the mandate still resulted in a substantial premium drop for well over 100,000 residents.
Today, I was able to fill in some of that missing data...although some of it is still frustratingly absent.
Last fall, I reported that thanks to the one-two punch of a) reinstating the ACA's individual mandate penalty at the state level and b) using the revenue generated from the mandate penalty to help fund a robust reinsurance program, the state of New Jersey had successfully lowered average unsubsidized premiums for 2019 individual market policies by a net swing of nearly 22 percentage points.