In late May, I noted that Blue Cross Blue Shield of North Carolina, which holds a near monopoly on the individual market in NC with around 95% of total enrollment, had submitted an initial rate hike request for 2018 averageing 22.9% overall. What was remarkable at the time is that while most carriers were pussyfooting around using euphamisms about the reasons for their excessive increase requests, BCBSNC was among the first to come right out and state point-blank that it's the Trump Administration's deliberate sabotage of the market--primarily via the threats to cut off CSR payments and to not enforce the individual mandate--that are responsible for over 60% of the increase. This is from their blog, not mine:
For 2017, North Carolina's unsubsidized, weighted average individual market rate hikes came in at around 24.2%. With carriers like Aetna, United Healthcare, Humana and Celtic all dropping out of the NC exchange market, there wasn't much math to do in order to find a weighted average: The only individual market carriers left were Blue Cross Blue Shield of NC, Cigna and "National Foundation Life Insurance", which is basically a non-entity shell company related to "Freedom Life", the less said about the better. Since Cigna only had around 1,200 indy market enrollees at the time (less than 0.5% of the total market share), that pretty much left BCBSNC as the only game in town, so their 24.3% hike was the whole shebang for the state.
As of 2017, Hawaii no longer has a SHOP exchange for small businesses. The State Department of Labor and Industrial Relations has an FAQ page about this.
...Hawaii’s waiver aligns the ACA with the state’s existing Prepaid Health Care Act. Under the Prepaid Healthcare Act, employees who work at least 20 hours a week have to be offered employer-sponsored health insurance, and can’t be asked to pay more than 1.5 percent of their wages for employee-only coverage (as opposed to 9.69 percent under the ACA in 2017).
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).
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.
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:
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.
It looks like I was right to be suspicious of the seemingly fantastic QHP enrollment numbers reported out of both North Carolina andLouisiana.
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 andLouisiana has me thrown for a heck of a loop (visit the links for details).