New York

Today's New York Daily News has an article with the following headline:

NYC man sues health care provider Fidelis Care, says Obamacare gave him few options and insurer's site was 'plagued with errors'

Hmmm...OK, he's suing a private insurance corporation, saying that the private insurance corporation's website was error-plagued. So what part does the ACA play in this?

Trying to find a gynecologist for his wife on a New York state health care exchange gave a Manhattan lawyer a major headache.

In papers filed in Manhattan Supreme Court, Robert Neal Halpern says he and his wife were automatically enrolled in Fidelis Care after their previous Affordable Health Care Act insurer, Official Health Plan Marketplace, went belly-up in November.


Deadline extended: enroll by Friday, December 19th for coverage beginning January 1, 2016. Apply now: #EnrollNY

— NY State of Health (@NYStateofHealth) December 15, 2015

Here's the official press release:

Press Release: NY State of Health Extends Enrollment Deadline for January 1 Coverage • Dec 15, 2015

New Yorkers Now Have Until December 19 to Enroll for Health Insurance Coverage that Begins January 1

If you take a look at the State-by-State chart, you'll notice that in addition to a few clarifications here and there, there are 5 states (well, 4 states +DC) all the way at the bottom labelled "NO DATA YET".

California insists, just like last year, on doing this weird thing where they release the number of new enrollees who have signed up on a fairly regular basis, but the number of renewals by current enrollees is kept a secret all the way into January. I have no idea why they do that, and it's pretty important given that we're likely talking about somewhere between 1.0 - 1.3 million people here.

On the other hand, at least they've posted data on their new additions. DC, Idaho, Kentucky, New York and Vermont haven't even done that much as of this writing.

The good news (relatively speaking) is that the 200,000-odd New Yorkers currently enrolled in about-to-be-defunct Health Republic NY Co-Op policies have been given an extra 15 days to find a new insurance provider (11/30 instead of 11/15), and that those who don't do in time will be automatically enrolled in a temporary (1-month only) policy with someone else to at least ensure coverage to tide them over through January. The temporary policy may or may not include their preferred doctors/hospitals, but it's better than having no coverage at all during the December gap period, anyway.

The bad news is that the hospitals & doctors who have been treating these folks until now may find themselves getting stiffed by the Co-Op's middle man, MagnaCare:

Things have been changing rapidly in the ongoing Health Republic of New York saga, and as recently as last night each development seemed to make the situation worse...but a few hours ago, Politco New York reporter Dan Goldberg posted a new story which indicates that the powers that be finally have some positive news:

In an effort to head off a potential health insurance disaster, state officials on Sunday announced a series of steps to protect roughly 200,000 customers who are set to lose their health coverage, and promised to investigate the company behind the crisis.

...And those were just the customers who were aware of the change. No one could say for certain how many were unaware they were about to lose their coverage, and other insurers operating on the exchange expressed concern that the customers most likely to pick a new plan were the ones most likely to be sick, a scenario of adverse selection that few companies were prepared to handle.


Just this morning I posted some significant updates in the ongoing, increasingly messy saga of Health Republic of New York, one of the ACA-created Co-Ops which is being shut down due to severe financial issues (partly due to the Risk Corridor Massacre debacle, but other reasons as well).

Once again, the short version is:

  • Most of the Co-Ops which are being shut down are at least able to cover their policies through the end of December, giving their current enrollees plenty of time to shop around and switch to a different insurance carrier. This was supposed to be the case for Health Republic of NY as well.
  • However, on October 30th, there was a surprise announcement by the NY Dept. of Financial Services (which includes insurance regulation) that instead of December 31st, the HRoNY policies are being yanked effective November 30th. Furthermore, current enrollees have only until November 15th to find a replacement to tide them over for December.
  • While one month may not sound like a big deal, it's a huge problem for at least some of the 200,000-odd people currently enrolled via HRoNY (note: I thought this number was down to 166K, but may be mistaken about the figure).
  • It's a major problem for some enrollees who are undergoing chemotherapy, for instance, or have other recurring medical services/treatments (many of which are expensive) which can't be "paused" for 31 days.

I wrote a couple of posts last week about the ongoing Health Republic of New York Co-Op meltdown, which has quickly gone from being just-another-Co-Op-closure to a complete disaster for up to 166,000 New York residents, primarily because unlike the other Co-Ops which are at least covering their existing enrollees through the end of December, Health Republic is now having the plug pulled out at the end of November, which gives current enrollees just 8 days to scramble to find new coverage for the last month of 2015.

This was made worse by the fact that the November 30 cut-off wasn't even announced until October 30, and even then, the powers that be in the NY Dept. of Insurance, NY State of Health exchange and Health Republic itself didn't appear to treat this development with any particular sense of urgency. I mean yes, they posted notices about it and supposedly sent out letters to all 166,000 people, but an awful lot of those people didn't appear to have received those notices as of a few days ago. Hell, until a day or two ago the NY State of Health website didn't even have anything posted about the 11/30 cut-off at all.

Well, I've been screaming bloody murder about the situation, as have others, and it seems to be getting some butts moving...but I'm not sure how helpful any of it will be.

First up: Dan Goldberg, a very good reporter for Politico New York, posted a big story about the mess on Thursday which no doubt forced some action:

IMPORTANT: If you're enrolled via Health Republic of New York and have questions about your situation, call this hotline: 855-329-8899

I don't know who's to blame for this. It could be the management of the about-to-be-defunct Health Republic of NY CO-OP. It could be someone at the NY State of Health ACA exchange. It could be someone at the NY Dept. of Financial Services. Perhaps it's all three.

What I do know is that this situation, which was already unacceptable several days ago...

Thanks to "Intheknow" from the comments for the heads up on this:


The New York State Department of Financial Services (NYDFS), the New York State of Health Marketplace  (NYSOH), and the Centers for Medicare and Medicaid Services (CMS) today announced additional actions regarding Health Republic Insurance of New York (“Health Republic”) and a transition plan for Health Republic customers.

OK, the "now" part in the headline is a bit misleading; it's possible that the NY State of Health exchange has been allowing 2016 window shopping for some time now and I just didn't notice. Still, I checked today and yes, NY residents can indeed shop around for 2016 Open Enrollment healthcare policies today:

Among the various provisions of the Affordable Care Act, the one which intrigued me the most was the creation of 23 "Consumer Operated and Oriented Plans", or "CO-OPs". The idea was to create non-profit quasi-public/private healthcare insurance organizations (similar in nature, I believe, to Credit Unions, except for health insurance), to compete with the private, profit-based insurance providers.

Unfortunately, as the Office of the Inspector General noted in a July report (in huge font size for some reason), after two Open Enrollment periods have come and gone, the ACA CO-OPs aren't doing very well for the most part, to put it mildly.

One of them, CoOportunity of Iowa and Nebraska, infamously melted down before the 2nd OE period was even halfway done.

After yesterday's ugly news about Alaska's private policy rate hikes, this is welcome relief:

Judge says Alaska Medicaid expansion can go ahead Tuesday

An Anchorage trial court judge Friday said that Alaska Gov. Bill Walker’s administration can expand the Medicaid health care program starting next week, dismissing a request by the state Legislature to temporarily block enrollment while attorneys fully argue lawmakers’ legal challenge.

In a 45-minute opinion delivered from the bench, Pfiffner rejected a series of arguments by the Legislature that starting expanded Medicaid enrollment Tuesday was so problematic that it should be put on hold while the Legislature’s lawsuit proceeds.

The actual lawsuit will still proceed, but this is still great news for up to 40,000 Alaskans.

Not such great news in Nevada, however:

Nevada Health Co-Op to close, leaving thousands to find new insurance

Just 2 days ago I posted an analysis of the New York individual market rate increase requests for 2016. My takeaway was that the weighted average requested was 10.0%, with the usual caveats about rounding errors, estimates of the total individual market size and so forth. Plus, of course, these were just requested increases, not final ones.

Today, the NY Dept. of Financial Services has made most of my number-crunching announcing that they've already completed reviewing the requests and have knocked them down several points:


Individual Rates for 2016 Remain Nearly 50% Lower than Before Establishment of New York’s Health Exchange
DFS Rate Reduction Actions Will Save Consumers More than $430 million
New Essential Plan Will Lower Premiums to $20 or Less and Provide Better Benefits for Lower-income New Yorkers

Earlier today I posted about a mountain of data being released by the New York State of Health ACA exchange, including, among many other data points, the rough market share breakdown of the 19 insurance carriers operating on the exchange this year, like so:

  • Fidelis Care: 20%
  • Health Republic: 19%
  • Healthfirst: 10%
  • Empire BCBS: 10%
  • MetroPlus: 7%
  • MVP: 6%
  • Emblem: 6%
  • Oscar: 5%
  • Affinity: 5%
  • Excellus BCBS: 4%
  • UnitedHealthcare: 2%
  • North Shore: 2%
  • BCBS West. NY: 1%
  • CDPHP: 1%
  • Independent: 1%
  • Univera: <1%
  • Wellcare of NY: <1%
  • Empire BC (Upstate): <1%
  • BlueShield of NE NY: <1%

The New York State of Health (NY's ACA exchange) just released detailed numbers from the 2015 Open Enrollment Period.

Unfortunately, the data gets cut off as of 2/28/15, so this doesn't give any insight into the attrition rate since then (or a precise count of how many additional people enrolled during the #ACATaxTime special enrollment period which followed). However, it does give a lot of detailed analysis of the open enrollment period numbers, and does tack on an extra week's worth of private enrollments & 2 week's worth of CH+/Medicaid numbers (the official HHS report only ran through 2/21 for New York and the last press release with CH+/Medicaid numbers was as of 2/15).

As a result, the official numbers are slightly higher than what I had until now across the board: