North Carolina

Blue Cross Blue Shield of North Carolina originally requested an 18.8% rate hike back in June, but after the Aetna pullout, they revised their request upwards to 24.3%. Cigna, which is expanding onto the ACA exchange next year, followed suit by bumping up their request from 7% to 15%.

I haven't seen any formal announcement from the NC Dept. of Insurance yet, but BCBSNC just posted the following blog entry announcing their 2017 rates...and it certainly looks like the 24.3% request was indeed granted as is:

Blue Cross and Blue Shield of North Carolina customers purchasing ACA plans on the individual market will see an average increase of 24.3 percent in their premiums for 2017, compared to this year’s rates. That’s higher than our original rate filing back in May (an 18.8 percent increase).

Back in June, the two carriers which will be participating in the North Carolina individual market next year (BCBS and Cigna) requested average rate hikes of 18.8% and 7% respectively. Since then, however, Aetna has dropped out of the indy market, which no doubt is a big part of the reason both of them have resubmitted higher rate requests:

Proposed rate changes for 2017 revised upwards

For the two carriers that are expected to participate in the exchange in 2017, the proposed average rate hikes for 2017 are:

  • Blue Cross Blue Shield of North Carolina: 18.8 percent 24.3 percent (new rates were filed in late August)
  • Cigna: 7 percent (based on current off-exchange plans) 15 percent (new rates were filed)

Aetna had proposed an average rate increase of 24.5 percent, but that is no longer applicable for exchange enrollees, as Aetna’s plans will not be available in the North Carolina exchange in 2017.

North Carolina's individual market, which only had 5 carriers participating to begin with this year, suffered a double blow recently when both UnitedHealthcare (155,000 enrollees) and Humana (3,272 enrollees) announced that they were dropping out of the market entirely next year (Celtic is also leaving the state, but they have literally just 1 person enrolled state-wide anyway). Fortunately, nature abhors a vacuum, so Cigna Health & Life Insurance decided to join the exchange for 2017. Cigna is already selling off-exchange individual policies, but only has fewer than 1,300 people enrolled in them at the moment. There's also a carrier called "National Foundation Life Insurance" which is raising rates 17.4%...but doesn't have a single person enrolled at the moment anyway, so I'm not sure what to make of that.

When UnitedHealthcare announced last month that they were making good on their threat last fall to pull out of the individual market in over two dozen states next year, it caused shockwaves across the health insurance industry. It is an important development, as around 800,000 people will be impacted.

When Humana announced last week that they plan on pulling out of the individual market in at least 5 states next year, it was interesting and a bit of a bummer, but not nearly as earthshattering, because only about 25,000 people will have to shop around and find a new carrier.

Today, it is my duty to announce that Celtic insurance has also decided to pull out of the entire individual insurance market (both on and off-exchange) across at least 6 states, including:

Ugh. Back in August I ran a ballpark estimate of the requested average rate hikes on the North Carolina individual market, and came up with 27% like so:

However, since then, 2 major NC insurers have revised their request upwards even further:

Two more health insurers in North Carolina are asking to increase their already-proposed rate increases. 

UnitedHealthcare, which had requested an average rate increase of 12.5 percent, now is asking regulators to allow an an average increase of 20.4 percent. The range is 2.5 percent to 50.3 percent.

Humana had requested 11.3 percent and is now asking for an average of 24.9 percent. 

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

As explained in the first link above, I've still been able to piece together rough estimates of the maximum possible and mid-range requested average rate increase for the North Carolina individual market:

BCBS of NC had previously requested an already-ugly 25.7% average rate hike, but has now asked to bump that up even more, to 34.6% overall.

Presented without comment:

North Carolinians could have three insurance carriers to choose from when enrollment under the Affordable Care Act reopens in November.

The state Department of Insurance has approved individual plans from UnitedHealthcare for the online marketplace, but they still need to be approved by the U.S. Department of Health and Human Services because the federal government operates the exchange.

BCBSNC reports 232,000 QHPs sold on the ACA exchange...but that's out of about 273,000 total enrollees; they've removed the other 15% who haven't paid their premium yet:

The Blue Cross enrollments reflect insured customers who signed up from October through May 1 and are still paying premiums. About 15 percent of customers who signed up never paid a premium and are not included in the 232,000 figure, Burke said. 

So, fine: 85% for Blue Cross of NC. As it happens, NC sold a total of 357,584 policies total, which means BCBSNC sold over 76% of the total.

Now, it's conceivable (but not likely) that 100% of the remaining 84,500 enrollees snapped up by other companies did pay their premiums, but even so, that would only bring the paid percentage up to about 88.5%. So, I think it's safe to say that for North Carolina, 85% is a reasonable "How many have PAID???" figure for the full state until more solid numbers are released.

This number out of NC is a bit squirrelly; I'm not updating the actual spreadsheet with it, but it's still worth at least mentioning:

Overall, Terrell said, the state has received 95,000 Medicaid applications via the federal ACA sign-up, representing 132,000 people, since October 2013. And that number is likely to grow. 

The number of people added to Medicaid/CHIP in NC thru 3/01 via the HC.gov site was 55,691, so this could potentially be a more than 2.3x increase, but they're noted as applications, so presumably some of them will be denied. Still impressive.

(SIGH) OK, in the words of Emily Litella..."never mind..."

It looks like I was right to be suspicious of the seemingly fantastic QHP enrollment numbers reported out of both North Carolina and Louisiana.

Thanks to Jed Graham (via Twitter) for pointing me towards Page 21/22 of the February HHS Report. Normally I only focus on the 3rd and 4th columns ("Determined or Assessed Eligible for Medicaid / CHIP by the Marketplace" and "Number of 
Individuals Who Have Selected a Marketplace Plan", since these are the actual exchange enrollment numbers through the end of that month.

OK, I either have some very good news...or one heck of a misunderstanding here.

Earlier today I updated both New York and Colorado's QHP numbers...and while both were very fine, they were actually down somewhat from last week (large drop for NY, small one for CO). This may actually make sense, as both of these state exchanges have been running very smoothly for months now; it's possible that they've simply started to reach the end of the line in terms of residents actually signing up (or perhaps they'll both experience a final mini-surge right at the tail end this weekend).

However, the apparent news out of both North Carolina and Louisiana has me thrown for a heck of a loop (visit the links for details).

Good gravy. 391,000 people in North Carolina?? They were only at 200,546 as of 3/01. Even if you assume this number includes Medicaid enrollments, that's still only another 55,691 as of 3/01...and NC is not an expansion state. Assuming that 391K includes both...and assuming the same 78/22 split between the two...that still suggests that QHPs have gone up to around 305,000, a 105,115 increase over the end of February, and over 3.8x the February daily rate.

If it doesn't include Medicaid (which seems likely from the wording of the article), then it's a whopping 190,454 increase--a doubling of their 3/01 total, and a near 7x increase over February.

I find either of these rather difficult to believe, so for the moment I'm only entering it into this blog entry. If I can confirm the QHPs as either of these I'll change it tonight or tomorrow.

OK, as noted a little earlier, I underestimated the February HHS Report for Exchange-based Private QHP enrollment by about 4.2%:

  • My Projection: 902,800 (4.202 million total)
  • Actual Enrollments: 942,833 (4.242 million total)

I'm perfectly happy to have underestimated. As for where the extra 40,000 enrollments came from, my initial guess would be that California, in particular, started ramping up their big March blitz a bit earlier and more successfully than I figured, which, again, I'm absolutely fine with. Update: Nope, actually, California's numbers plummetted in the 2nd half of Feb due to that ugly technical outage; see below for details.

I'm busily plugging the new enrollment numbers into the spreadsheet even as I type this, and will be updating with various notes and observations, so keep checking in.

OK, I've entered the QHP data; a couple of things to note:

UPDATE: On the down side, I was off by 4% this time around.

On the up side, I UNDERESTIMATED:

Actual Feb. enrollments: 942,833, for a total of 4,242,325 thru 3/01/14.

Sarah Kliff at Vox just announced that the February HHS report is expected to be released today at around 4:00pm. A few items in anticipation of that:

  • As I've noted several times, I'm projecting the report to total around 902,000 exchange-based private QHP enrollments for the month of February (technically 2/02 - 3/01)
  • If accurate, this would bring the cumulative total of exchange-based private QHP enrollments to 4.202 million (from 10/1/13 - 3/01/14)
  • From the data I have, the average daily enrollment rate in February was almost identical to that of January, which had about 1.146 million QHP enrollments. HOWEVER, the January report included five weeks of data (12/28 - 2/01), while the February report will only include four weeks (2/02 - 3/01). Therefore, even at the same daily average, it'll be about 20% lower no matter what.
  • Don't be surprised if Peter Lee of CoveredCA decides to steal some thunder by announcing that California has enrolled 1,000,000 QHPs all by itself either today or tomorrow. However, that would include the past 10 days, while the HHS number will only run thru 3/01.
  • If you want to get REALLY specific, call it 902,800 and 4,202,292.
  • I've been dead-on target 6 times in a row without hyping up my projections beforehand. This time I am hyping myself up beforehand, so I'll probably be way off...but as long as I've UNDERestimated the tally, I'll be perfectly fine with that...
  • The report will be released in about 5 minutes, but my kid gets home from school in about 10, so it'll be a good 20 minutes before I can really post anything. Feel free to follow Sarah Kliff of Vox in the meantime!