END OF 2018 OPEN ENROLLMENT PERIOD (41 states)

Time: D H M S

South Carolina

A couple of weeks ago, a joint letter was sent to all four Congressional leaders from AHIP (America's Health Insurance Plans), the BlueCross BlueShield Association, the American Academy of Family Physicians, the AMA, the American Hospital Association and the Federation of American Hospitalsm warning them, in no uncertain terms, of what the consequences of repealing the individual mandate would be:

We join together to urge Congress to maintain the individual mandate. There will be serious consequences if Congress simply repeals the mandate while leaving the insurance reforms in place: millions more will be uninsured or face higher premiums, challenging their ability to access the care they need. Let’s work together on solutions that deliver the access, care, and coverage that the American people deserve.

A week or so ago, the American Academy of Actuaries sent a similar letter to Republican Senate Majority Leader Mitch McConnell stating pretty muc the same thing, but in more vivid detail:

As the final deadline for final 2018 individual market rates to be locked in and the contracts signed, more states are coming into focus, and the pattern continues to be remarkably consistent.

In Mississippi, I originally pegged the requested rate hikes across the two individual market carriers (technically three, but "Freedom Life" is a phantom carrier with only 2 alleged enrollees) at 16.1% if CSR payments are made and 39.6% if they aren't. It turns out I was off by a bit, however, because I didn't realize that BCBS of Mississippi was only selling policies off-exchange next year. That means the CSR issue won't impact them either way, since none of their enrollees would receive the assistance anyway.

I admit to being a bit confused about the distinction between BCBSSC and BlueChoice HealthPlan, which is also a BCBS carrier...I'm guessing one is for HMOs, the other for PPOs or something. In any event, BlueChoice plans appear to only be available off-exchange, and are thus not subject to the CSR issue. BCBSSC is, however, and the Kaiser Family Foundation estimates that their Silver plans would have to go up 23% if CSR payments are cut off. 87%% of SC exchange enrollees are on Silver plans, so that should be roughly 20.2% across all policies.

If CSR payments are made, South Carolina is looking at around a 13.2% average rate hikes; if they aren't, it's an uglier 32.5%.

Over the past few months, my Congressional District Breakdown tables estimating how many people would likely lose healthcare coverage if the ACA were to be "cleanly" repealed (with no replacement) have gotten a lot of attention. This was followed by the Center for American Progress (CAP) running their own estimates of how many would likely lose coverage if, instead of a "clean" repeal of the ACA as a whole, the ACA were to be partially left in place, with the GOP's AHCA (Trumpcare) bill, which dramatically changes the ACA, being signed into law instead.

As I noted when I crunched the numbers for Texas, it's actually easier to figure out how many people would lose coverage if the ACA is repealed in non-expansion states because you can't rip away healthcare coverage from someone who you never provided it to in the first place.

My standard methodology applies:

As noted before, I'm really trying to move onto the actual enrollment part of the 2017 open enrollment period, but I can't resist doing some more final cleanup of my Rate Hike project:

  • SOUTH CAROLINA: This is one of the 5 states which I still didn't have approved rate changes for. Today the RateReview.HC.gov site finally added in the final numbers for SC, so here's what it looks like:

Aetna was a bit tricky--the total enrollee number is actually 41,988. They dropped out of the ACA exchange but are sticking around the off-exchange market, so I had to figure out how many of those 42K are on vs. off-exchange. The answer is in this article which notes:

More than 220,000 South Carolinians rely on the federal health care law for insurance. This year, only 8,000 of them are covered by Aetna plans.

As of 2014, South Carolina's total individual market was roughly 201,000 people, including grandfathered & transitional enrollees. 205,000 people were enrolled in exchange policies as of the end of March 2016; when you add off-exchange enrollees, it's likely closer to 250K, of which I'd imagine 225K or so are ACA-compliant. The enrollment numbers below therefore should reflect roughly 70% of the ACA-compliant market.

To calculate the Blue Cross Blue Shield average percentage, I had to do a bit of guesswork as to the proportion of their 116,000 enrollees between the 3 different types of plans (BlueEssentials, Multistate and Catastrophic). BlueEssentials is the highest of the three (14.74%), but also likely holds the vast majority (I'd guess 95% or more); usually very few people select Catastrophic plans, and I don't think many go for Multistate either. Therefore, I'm eyeballing the overall average at around 14.4%.

(sigh) I thought the dust had settled on the Risk Corridor Massacre, but apparently not:

~67,000 need to find new 2016 coverage, SC DOI tells me. CCHP is the ninth co-op to announce closure so far.

— Rachel S. Karas (@rachelkaras) October 22, 2015

Consumers’ Choice Health Insurance Company Agrees to Wind Down Its Operations

COLUMBIA, SC – Consumers’ Choice Health Insurance Company (Consumers’ Choice) has agreed to a voluntary run-off and will not offer health insurance coverage in 2016.

“This was a difficult decision for the insurer and this agency, but this is what is in the best interests of South Carolina consumers and health care providers,” said Ray Farmer, Director of the South Carolina Department of Insurance.

“The recent announcement of a risk corridor reimbursement of just 12.6% cast doubt on the collectability of tens of millions of dollars through the federal risk corridor program and led to an unavoidable outcome,” said Jerry Burgess, President and CEO of Consumers’ Choice.

Thanks to David Snow for the heads up!

A couple of weeks ago, both Louise Norris and I crunched the South Carolina data and came up with different estimates of the weighted average requested 2016 rate hikes for the ACA-compliant individual market. She used a worst-case scenario and estimated it to be around 16.8%; I took a slightly more optimistic approach and came up with 15.2%.

Well, the South Carolina Dept. of Insurance just released their approved 2016 rates, and they ended up pretty much splitting the difference.

As you can see, even though there are only 5 carriers operating on the ACA exchange and another 5 offering policies off-exchange only, the overall average is still 15.9% either way:

It's been awhile since I've crunched the numbers for a new state. As I noted a week ago, I've covered 42 states representing 87% of the total population, so any further changes assuming 100% of current enrollees stay with their current policy are likely to be fairly nominal unless various insurance regulators surprise me and slash the approved rate hikes significantly in a few states.

Thankfully, Louise Norris has picked up the ball and seems to be filling in some of the missing pieces using my own methodology, including North Dakota and South Carolina. I'll tackle the Palmetto State first:

Rates have not yet been approved for 2016, but Healthcare.gov’s rate review tool shows proposed rates from carriers that have requested rate increases of ten percent or more.  In South Carolina, that applies to two current exchange carriers:

UPDATE 5/19/15: SEE IMPORTANT UPDATE TO THE LUIS LANG SAGA!!

Yeah, that's right, I'll say it: Luis Lang is a hypocrite.

Over at Talking Points Memo, Josh Marshall has a story about a guy in South Carolina named Luis Lang who's in a nasty situation due to a combination of bad timing, Republican cold-heartedness and, to be blunt, his own stupidity.

First, the backstory:

As the Charlotte Observer explains, Lang is a self-employed handyman who works as a contractor with banks and the federal government to maintain foreclosed properties. He was making a decent living, enough to be the sole breadwinner in the family. As the Observer puts it, Lang "he has never bought insurance. Instead, he says, he prided himself on paying his own medical bills."

As if we needed even more examples of how utterly full of hooey the chief argument of the King plaintiffs is:

S.C. health care committee didn’t know Obamacare subsidies were in jeopardy

A decision made more than three years ago by a committee that no longer exists might deal a major blow to Obamacare in South Carolina this summer.

...Former members of the S.C. Health Exchange Planning Committee say they weren’t aware in 2011 that their opposition to a state-based insurance marketplace might jeopardize so many people’s ability to pay for coverage.

“At no point in the committee’s discussion was there ever raised a concern that by opting into the federal exchange we were losing anything — especially subsidies,” said Tim Ervolina, president of the United Way Foundation of South Carolina and a former planning committee member. “I recall a very intense discussion with (former) Sen. (Mike) Rose, who stated that, after reviewing the law, he felt confident that we had nothing to lose and everything to gain by opting into the federal exchange.”

Unfortunately, there aren't any specific enrollment numbers given out in this article, but the 3rd paragraph includes a hell of an eye-opener...especially given that this is in deep-red South Carolina:

Last year, insurance agents and federally funded navigators were sitting around their computers, hoping to get into the balky website in the first few weeks after it went online on Oct. 1. When they were able to log in, the system moved at a snail’s pace. The rollout was viewed as a disaster for the Obama administration and the early implementation of the insurance mandate in the Affordable Care Act.

This year, the problem has been finding enough time to help the early rush of people who want to either shop for the best policy or go ahead and enroll. At Richland Library, the appointments for enrollment help are booked through the end of November.

Oregon: Most ACA exchange enrollees previously uninsured, most consider themselves healthy:

Those are two of the findings of a survey released today by the Center for Outcomes Research & Education at Providence Health Services. The goals were to understand who enrolled, assess their connection to care before and after enrollment and to understand their health. At the time of the study, 76,569 Oregonians had signed up through open enrollment.

If I'm going to boast about the states where high percentages of QHPs are paid for (WA, MA, CT, OR, WV & RI, for starters), I do have to be honest and present the lower figures as well. According to the SC insurance commissioner, only about 71.3% of exchange QHPs in that state had been paid up as of 4/30, which is admittedly not great:

Of the 119,784 individuals in South Carolina who applied and selected a policy on the federal exchange, 85,453 - about 71 percent - paid their first month's premium by April 30, Farmer said. That was the last possible day to make that first payment. Those who didn't pay by that date aren't actually insured, he said.

As a side note, that 119,784 figure is actually higher than the official 4/19 HHS total of 118,324; presumably another 1,460 trickled in from 4/20 - 4/30. Even using the lower number, however, the paid rate would only be 1% higher (72.2%).

I should also note that while 71% isn't very good, it's still 10% higher than the 61% that the GOP House Committee report claimed for SC last week.

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