New Mexico

2018 MIDTERM ELECTION

Time: D H M S

Last week I made a valiant effort to convert my 2016 individual market percentage rate ncrease project into actual dollar figures--that is, I tried to figure out how much premiums are likely to increase, on average, in each state, in actual dollars. After all, saying that a policy premium "went up 50%" while another "only" went up 5% for the same person doesn't tell you much if the first one started out at $200/month and the second one was already $300/month. Unfortunately, I failed at doing this; way too many variables and too much missing data.

However, I am able to provide a sneak peak at average rates on the New Mexico individual and small group markets next year, for individual enrollees at 5 different ages, in all 5 different coverage regions:

When I last checked in on the ongoing saga between the New Mexico Insurance Commissioner and Blue Cross Blue Shield of New Mexico, BCBS was threatening to take their ball and go home if NM Insurance Commish John Franchini didn't cave and agree to let them jack rates up by 51% on the individual market (Franchini had agreed to a 24% hike instead).

Well, Franchini called BCBS's bluff...but they weren't bluffing:

Thousands of New Mexicans will need to shop for new health insurance plans later this year after a decision by Blue Cross Blue Shield to stop offering individual insurance plans through the state health exchange beginning Jan. 1.

...The letter said Blue Cross Blue Shield of New Mexico lost $19.2 million in 2015 on the 35,000 individuals covered by plans they purchased on and off the exchange.

...Blue Cross will offer a basic-level insurance plan outside the exchange in 2016, which will be available to all consumers at the same rate as in 2015.

Last week I reported that insurance companies offering individual healthcare policies in New Mexico were asking for some pretty ugly rate hikes (on a percentage basis, anyway), mainly due to Blue Cross Blue Shield of NM (aka "Health Care Services Corp.") putting in for a jaw-dropping 57% hike. This resulted in 30% overall requested increases when weighted by market share.

Then, a few days later, the New Mexico state insurance commissioner announced the approved rate hikes for all 5 (or is it 6? see below...) of the companies in question. For BCBSNM (aka HCSC), they lopped the 57% hike down massively:

UPDATE 8/9/15: OK, something really strange is going on here...

BCBS of New Mexico won't have opportunity to submit new rates. They can either keep '15 premiums or not sell individual plans next year.

— Paul Demko (@pauldemko) August 8, 2015

@charles_gaba @khemp64 Nothing approved. NM regulator says Blue Cross wanted to hike rates 51.6%; BCBS says revised plan raised rates 11.3%

— Paul Demko (@pauldemko) August 9, 2015

@charles_gaba @khemp64 It's not clear to me how they could possibly be that far off on the numbers.

— Paul Demko (@pauldemko) August 9, 2015

Thanks to both Scott M. and Colin Baillio for the heads' up...

IMPORTANT: See this detailed explanation of how I've come up with the following estimated maximum requested weighted average rate increases for New Mexico.

As explained in the first link above, I've still been able to piece together rough estimates of the maximum possible and most likely requested average rate increase for the New Mexico individual market:

Again, the full explanation is included in the Missouri estimate linked at the top of this entry, but to the best of my knowledge, it looks like the companies with rate increases higher than 10% come in at a weighted 43.3% increase, but only make up about 62% of the total ACA-compliant individual market, with several other companies with approved increases of less than 10% (decreases in some cases) making up the other 38%.

This AP article provides snippets about a handful of states; it'd be nice if they just released the actual report so we could see the hard expansion numbers (as opposed to the total increase numbers, which are still obviously useful but don't distinguish between traditional Medicaid and ACA expansion enrollees):

In Kentucky, for example, enrollments during the 2014 fiscal year were more than double the number projected, with almost 311,000 newly eligible residents signing up. That's greater than what was initially predicted through 2021. 

...At least 14 states have seen new enrollments exceed their original projections, causing at least seven to increase their cost estimates for 2017, according to an Associated Press analysis of state budget projections, Medicaid enrollments and cost details in the expansion states. A few states said they could not provide original projections.

On the one hand, this isn't nearly as big of a shock to me as it wsa when Michigan hit 600,000 enrollees (a full 100K higher than earlier eligibility estimates).

On the other hand, 36,000 more people covered than you expected is still 36,000 more people covered!

As you can see from the NM Medicaid enrollment report below (click on it to see the full-size version), as of the end of March, New Mexico was up to 205,901 people enrolled specifically in the ACA expansion program. According to the NM Human Services Dept., the state was only expecting around 170,000 people total to even be eligible.

Of course, that was in March. According to their latest projections from May, they estimate expansion enrollment has reached around 222,000 as of today...and are now projecting it to reach over 241,000 by next June. If that proves accurate, they'll have enrolled nearly 42% more people than expected.

I've written a lot about how the 2016 policy rate increase request numbers flying around in scary-sounding headlines at the moment are misleading for a bunch of reasons:

Today I've learned of another example of why it's silly to start wringing your hands yet. This morning I received the following tweets

The impending King v. Burwell Supreme Court decision will cast an even larger shadow over the ACA over the next 2 months (the decision is expected to be announced in June), as exchanges in 6 of the 14 states running their own (State-Based Marketplaces, or SBMs) are at risk of either being abandoned, dissolved or otherwise moved over to the federally-run Healthcare.Gov exchange:

The federal government is threatening to take over Hawaii's health insurance exchange within months and has restricted grant money to support operations of the Hawaii Health Connector.

Jeff Kissel, the Connector's executive director, told lawmakers at a briefing Thursday that if the exchange created by the Affordable Care Act does not get state funding soon, the federal government will abolish Hawaii's marketplace and run it directly.

I'm back from a short vacation to Chicago (we had a blast, thanks for asking...visited the Shedd Aquarium, Adler Planetarium and Museum of Science & Industry), so obviously my in box has built up quite a bit of ACA news over the past week.

It'll take awhile to sift through everything, but in the meantime there are some state-specific developments which stand out:

MONTANA: A couple of years back, Montana held a vote on the ACA Medicaid expansion provision. It was a tight vote, but should have passed...unfortunately, one state legislator accidentally voted the wrong way on the bill. Seriously:

Some states have declined to expand Medicaid because they oppose Obamacare. Others worry about the financial burden of expanding the entitlement. But there appears to be only one state where the Medicaid expansion failed due to a Democratic legislator accidentally voting against it.

Congratulations, Montana.

This is an excellent overview of how healthcare pundits, politicos, reporters and industry folks are keeping a very close eye on the ACA exchanges this weekend, as the December 15th deadline for January coverage approaches (well, for most states, that is; 6 states now have deadlines later than the 15th). It's well worth a read, as it goes into the whole "manual renewal" vs. "autorenewal" issue and a whole mess of other stuff.

However, towards the end are two additional data points:

CMS officials, including Marketplace CEO Kevin Counihan have been reassuring about auto-enrollment, said Martin Hickey, CEO of New Mexico’s co-op health plan. “It’s a stressor, but I haven’t seen him biting his fingernails,” Hickey said of Counihan. “But you never know.” His own health plan has had 3,ooo people sign up as of Dec. 10 through HealthCare.gov and the pace is picking up.

There's been a lot of fuss made about 2015 ACA exchange premium rates not being available at Healthcare.Gov until after the election. The presumption, of course, is that this is being done for political reasons. While this may be true, it could also simply be that there's a lot of different policy figures to plug into the federal system, and some states haven't even finalized their rates yet.

That being said, residents of some states can check out the 2015 premiums now and compare them against their current premium:

IDAHO: Idaho is the only state moving from HC.gov to their own exchange. Idaho residents can check out their 2015 rates directly via the state exchange site.

CALIFORNIA: CoveredCA has 2015 rates available right now as well.

When I last checked in on New Mexico's Medicaid expansion program, they were at around 55% of the total eligible. As of late August (judging by the Sept. 1st byline on the article), that number was up to 71%:

New Mexico projected that Medicaid expansion would sign up 219,000 new enrollees over a six-year period. In the first year alone (2014), they have already signed up 155,000, 71% of the best-case six-year estimate. 

This is really just a confirmation of an entry from 3 weeks ago, but this time I have more specifics on the premium changes at hand in New Mexico:

Among the five insurance carriers participating in the exchange, premiums will drop on average by 7 percent at Molina Healthcare, 1.5 percent at New Mexico Health Connections and 1 percent at Blue Cross and Blue Shield of New Mexico, according to the state Office of the Superintendent of Insurance.

The highest, lowest and roughly mid-range monthly payments for HMO health insurance plans offered by companies participating in the New Mexico Health Insurance Exchange. The payments are based on charges for a 50-year-old, non-smoking resident of the Albuquerque metro area for 2015. For more information, go to the exchange website atwww.bewellnm.com.

Premiums will be unchanged at Presbyterian Health Plan. The fifth insurance carrier participating in the exchange, Christus Health Plan, is in its first year.

This Just In...3 out of the 5 insurers operating on the New Mexico ACA exchange are dropping their 2015 premium rates. A fourth is increasing theirs, and the fifth one is new. The overall average is a 1-2% drop, although I can't tell whether that's a weighted or unweighted average (neither the enrollee breakdown nor the actual % change for the individual companies is included in the article):

Individual health insurance premiums in New Mexico will drop by an average of 1 to 2 percent in 2015 for those who buy on the state’s health insurance exchange, New Mexico Superintendent of Insurance John Franchini said Wednesday.

Franchini’s office released the new individual rates from the five insurers that will be selling on the exchange. Three of those insurers – New Mexico Health Connections, Blue Cross and Blue Shield of New Mexico and Molina Healthcare of New Mexico – saw some decreases in their overall rates from this year, said Aaron Ezekiel, head of Affordable Care Implementation for the Office of the Superintendent of Insurance.

Presbyterian Health Plan had some increases, Ezekiel said. CHRISTUS Health Plan is new to the exchange.

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