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.
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.
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.
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.
Nice find by Esther F. The main focus of the story is that a 5th insurance company has decided to join 4 others on New Mexico's ACA exchange, which is of course good news for competition, the free market and so forth...
The newest insurer is CHRISTUS Health Plan of Texas, Franchini said during a meeting of the NMHIX board in Santa Fe.
“CHRISTUS is a nonprofit and they will be on the exchange. They will be the fifth carrier on the exchange,” Franchini said.
CHRISTUS will join New Mexico Health Connections, Presbyterian Health Plan, Blue Cross and Blue Shield of New Mexico and Molina Healthcare of New Mexico as the firms that will sell in the individual exchange.
...however, Esther notes a potentially far more significant section of the story farther down. The backstory is this: New Mexico has been planning on running their own exchange for the 2nd year of open enrollment, but has more recently been having second thoughts given the various technical issues faced by some of the other state exchanges. Therefore...
Some good news (relatively speaking) on the Massachusetts front: As you'll recall, the state which inspired the ACA (ironically due to the program being spearheaded by then-Governor Mitt Romney), and which has been operating under their state-level version of the law smoothly for some years now, had an incredibly embarrassing misfire with their ACA-specific exchange website. After hobbling through the first enrollment period (and leaving over 200,000 residents in healthcare limbo as a result), it was determined that the existing site was such a mess that they had two choices: Either replace the existing software with an entirely new system, or drop the whole thing and move over to the Federal exchange as Oregon is doing.
Instead, Massachusetts decided to hedge their bets and pursue both: They've been working with a new vendor to rebuild their own exchange from scratch, while simultaneously arranging for a quick move to HC.gov just in case Plan A doesn't work out.
The good news is that so far, anyway, the new platform seems to be working out in early testing, though it's way too early to be sure of anything:
An estimated 220,000 New Mexicans are eligible for expanded Medicaid benefits, and 121,000 of them signed up for the newly available coverage. Many of them found their way to Medicaid by visiting the insurance exchanges online, by talking with guides, or at enrollment events designed to encourage use of the exchange.
As I noted yesterday, there are three states which had unusually large discrepancies between the official HHS and state exchange QHP enrollments:
New York came in over 65,000 lower than the number I had for a simple reason: The New York exchange lumps enrollees in their Child Health Plus program in with QHPs, even though technically this isn't a QHP program. There were over 40,000 of these as of the end of February; this number has climbed to 65,028 as of 4/19.
Since Child Health Plus is privately funded (and therefore isn't on the Medicaid/CHIP side), but also isn't officially a QHP either according to HHS, I've moved it over to the "Off Exchange QHP" column.
Impressive numbers from New Mexico during the extension period:
Nearly 35,000 New Mexicans had enrolled in health plans through the state and federal insurance exchanges as of April 15, a 32 percent increase from the end of March, the New Mexico Health Insurance Exchange said Friday.
As of March 31, 24,412 residents had enrolled through the exchanges, and as of April 15, that number had climbed to 34,966, as 8,554 residents took advantage of the extended enrollment period, NMHIX said.
Nothing major, just another 4,000 people added to NM's Medicaid tally:
An estimated 107,000 New Mexicans have enrolled in Medicaid since the state expanded the qualifications in October to include low-income adults, state Human Services Department spokesman Matt Kennicott said Monday.
...A total of 26,412 New Mexicans had enrolled in health plans through the state insurance exchange by the March 31 enrollment deadline, the state office of the Superintendent of Insurance said in a news release issued recently.
...An additional 10,000 applications had been submitted by the deadline but remained unprocessed, the statement said.
The New Mexico Health Insurance Exchange (NMHIX) reported a total of 26,412 New Mexicans had enrolled in qualified health plans as of March 31, 2014, according to the Office of the Superintendent of Insurance. This figure represents a 76 percent growth rate from the 15,012 enrollments confirmed at the end of February 2014.
In addition, as noted this morning, NM reports 11K OFF-exchange individual QHPs and another 13,500 off-exchange SHOP QHPs! The 11K are part of the alleged "9M" RAND QHPs, not sure how to handle the 13.5K SHOP QHPs, not that it makes much of a difference vs. 9M...