New York

2018 MIDTERM ELECTION

Time: D H M S

As you may recall, the New York carriers had originally requested an average 2019 rate increase of 24%...fully half of which they pegged specifically on the ACA's individual mandate being repealed by Congressional Republicans.

On Monday afternoon, there was a rather surreal and surprising announcement made by New York Governor Andrew Cuomo:

Gov. Cuomo just announced that he has directed Supt. Vullo to reject any individual market rate increase that included an increase to compensate for the repeal of the individual mandate

...Assuming that nothing else changes during the rate review process, this makes carriers that didn't associate a % of their rate request with the loss of the mandate big winners...and those who did, not so much.

I noted at the time that while this may seem insane on the face of it, there may be a simple explanation:

 

Monday afternoon there was a hell of a jaw-dropper out of the Empire State:

Gov. Cuomo just announced that he has directed Supt. Vullo to reject any individual market rate increase that included an increase to compensate for the repeal of the individual mandate

...Assuming that nothing else changes during the rate review process, this makes carriers that didn't associate a % of their rate request with the loss of the mandate big winners...and those who did, not so much.

Sure enough, after watching the half-hour speech by Cuomo, it sure as hell sounded like he was doing exactly that: Instructing the state insurance commissioner to only allow 2019 ACA individual market premiums to increase by around the 12.1% (on average) that they were expecting to go up with the ACA's individual mandate penalty in place instead of the roughly 24% (on average) that they said they'd have to raise them to cancel out the adverse selection impact of the mandate being repealed:

Michael Capaldo is an employee benefits consultant and self-described "ACA wonk" out of New York.

I don't know him beyond some in-depth wonky online discussions, but I don't see any reason for him to make the following up:

Gov. Cuomo just announced that he has directed Supt. Vullo to reject any individual market rate increase that included an increase to compensate for the repeal of the individual mandate

— Michael Capaldo (@consultbenefits) July 30, 2018

Assuming that nothing else changes during the rate review process, this makes carriers that didn't associate a % of their rate request with the loss of the mandate big winners...and those who did, not so much.

— Michael Capaldo (@consultbenefits) July 30, 2018

Hot on the heels of Washington State releasing their preliminary 2019 individual market rate hike request comes a similar press release out of the New York Department of Financial Services...and neither the carriers nor the state regulators are making any bones about the reason for next year's rate increases:

PROPOSED 2019 HEALTH INSURANCE PREMIUM RATES FOR INDIVIDUAL AND SMALL GROUP MARKETS

Health insurers in New York have submitted their requested rates for 2019, as set forth in the charts below.  These are the rates proposed by health insurers, and have not been approved by DFS.

 

The Basic Health Program is one of the more obscure provisions of the Affordable Care Act. Very few people outside of the healthcare wonk community know anything about it...unless they live in Minnesota or New York State.

The short version is that it's an optional low-income healthcare program designed for people at the income tier just above Medicaid expansion...138% - 200% of the Federal Poverty Line, or between around $16,600 - $24,100/year for a single adult. In most states people in that income range would be expected to enroll in heavily-subsidized ACA exchange policies. In New York and Minnesota, however, they've instead set up Basic Health Programs (BHPs) for this population instead.

Press Release: NY State of Health Releases 2018 Enrollment by Insurer
Mar 14, 2018

Consumer Choice Continues to be a Hallmark of the Marketplace

ALBANY, N.Y. (March 14, 2018) -- NY State of Health, the state’s official health plan Marketplace, today released data showing 2018 health plan enrollment by insurer. Statewide, 12 health insurers offer Qualified Health Plans (QHP) to individuals and 15 health insurers offer coverage to Essential Plan (EP) enrollees through the Marketplace. Ten health insurers participate in all individual market programs offered through NY State of Health allowing consumers a smooth transition if their program eligibility changes. Throughout the 2018 Open Enrollment Period, most consumers had a choice of at least four health insurer options in every county of the State. 

Press Release: NY State of Health Releases County-Level Enrollment Data

Feb 27, 2018

ALBANY, N.Y. (February 27, 2018) -- NY State of Health, the state’s official health plan Marketplace, today released county-level enrollment data as of January 31, 2018, showing that overall enrollment increased in each of New York’s 62 counties. Total enrollment in the Marketplace is now over 4.3 million people, reflecting an increase of 700,000 people (19 percent) from 2017.  Many upstate counties saw significant enrollment gains in the last year.

“Consumers from Chautauqua to Suffolk and every county in between are shopping for health plans through the Marketplace,” said NY State of Health Executive Director, Donna Frescatore. “With affordable premiums and a robust choice of plans, NY State of Health is where New Yorkers go to get covered.”

This Just In, courtesy of Dan Goldberg of Politico New York...

.@charles_gaba NY releases final numbers --253,102 in QHP with 41% receiving NO financial assistance. (That's amazing!) 738,851 in Essential Plan 374,577 in Child Health Plus

— Dan Goldberg (@DanCGoldberg) February 1, 2018

New York had already broken their 2017 numbers (just barely) a couple weeks ago, so this is effectively icing on the cake: Total QHP selections are up 4.2% year over year vs. the 242,880 they signed up last year.

Nothing new or noteworthy here, but I've posted the "last call" press releases for California and DC, so I figured with just 8 hours left to go I should do so for New York as well:

ALBANY, N.Y. (January 24, 2018) – NY State of Health, the state’s official health plan Marketplace today announced that New Yorkers who have not yet signed up for coverage in a Qualified Health Plan (QHP) should enroll now so they are covered for 2018. Open Enrollment ends January 31st. Consumers across the state have a choice of multiple health plan options and for many, coverage is more affordable than last year.

Enrollment through NY State of Health continues to climb to record levels with more than 4.2 million enrolled across all programs. As of January 16, 2018, 243,600 consumers have enrolled in a Qualified Health Plan (QHP) and 726,300 have signed up for the Essential Plan, exceeding numbers at the end of open enrollment in 2017.

 

If you look at The Graph for the 2018 Open Enrollment Period, you'll notice that in addition to the large green section (Qualified Health Plan (QHP) selections across the 39 Healthcare.Gov states) and the smaller blue section (QHP selections across the 12 State-based exchanges), there's a much smaller burgundy slice at the top labelled "BHPs (MN/NY only). This represents around 820,000 people in Minnesota and New York only who are enrolled in Basic Health Plans, or BHPs.

Press Release: Governor Cuomo Ensures Medicaid Coverage for DACA Recipients Regardless of Federal Action
If Congress Does Not Act to Protect DACA, New York DACA Recipients will Remain Eligible for State-Funded Medicaid

Governor Andrew M. Cuomo today announced that recipients of the Deferred Action for Childhood Arrivals policy will remain eligible for state-funded Medicaid, regardless of any federal changes to or termination of the program. There are approximately 42,000* DACA recipients in New York, many of whom are at risk of losing their employment-based health insurance if the federal government changes or terminates the program. Under New York law, DACA recipients are considered PRUCOL (Permanently Residing Under Color of Law) and eligible for state-funded Medicaid or CHIP.

Note: This is slightly lower than my own spitball estimate of around 50,000 DACA recipients.

No official link or press release yet, but This Just In from Politico NY's Dan Goldberg...

.@charles_gaba new numbers from NY

243,600 -- qhp surpassing last year's
726,300 in the Essential Plan

— Dan Goldberg (@DanCGoldberg) January 18, 2018

Last year, New York State of Health enrolled a total of 242,880 people in ACA exchange policies; this means they're slightly ahead of that number with two weeks left to go before the January 31st Open Enrollment deadline. This makes NY the fifteenth state to surpass last year's total...as well as the 7th State-based Marketplace (or the 10th if you include SBMs which are piggybacking on the federal exchange platform). I'll be writing something up about that later today.

THIS JUST IN via Dan Goldberg of Politico NY...

.@charles_gaba New NY numbers As of Dec. 15

2.9 million people in Medicaid
229,000 in qhp
364,000 enrolled in Child Health Plus
716,000 in Essential Plan

— Dan Goldberg (@DanCGoldberg) December 20, 2017

For context, as of 12/17/16, New York had enrolled 213,248 people in Qualified Health Plans (QHPs), putting them over 7% ahead of the same point last year...and unlike most states, New York's Open Enrollment Period is just as long as prior years, running all the way out to January 31st.

Put another way: New York's final enrollment tally last year was 242,880, meaning they're just 6% away from breaking that number with six weeks left to go. Their all-time record was set in OE2 with 409,000 QHP selections, but that's a meaningless comparison since the Essential Plan was added the following year, cannibalizing several hundred thousand enrollees anyway.

About a week ago, New York State of Health reported they had enrolled 166,000 people in Qualified Health Plans (QHPs) as of December 7th, plus another 710,000 in their Essential Plan (NY's name for the BHP program). The QHP number was around 13% ahead of the same point last fall.

Today they provided another (partial) update:

Press Release: As Major Enrollment Deadline Approaches, NY State of Health Enrollment Remains High 

Dec 13, 2017

New Yorkers Are Encouraged to Enroll by Friday, December 15th for January 1st Health Coverage

When NY State of Health released their first Open Enrollment update a week or so ago, they reported over 140,000 QHP selections in the first 28 days (up 13% vs. the same point last year) and 700,000 BHP enrollees (which is 5% more than they enrolled in all of last year's open enrollment period).

Today they've issued another update:

  • Enrollment in Qualified Health Plans and Essential Plan Reaches Nearly 900,000
  • December 15th is the Deadline to Enroll for January Coverage
  • New Yorkers Urged to Enroll Now

ALBANY, N.Y. (December 7, 2017) - NY State of Health, the state’s official health plan Marketplace, today announced enrollment in Qualified Health Plans (QHP) and the Essential Plan have reached nearly 900,000—continuing to outpace enrollment at the same point last year by 13 percent.

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