Tennessee

As most people know by now (well, most people in Tennessee, anyway), Humana decided a full two months ago to bail on the entire individual market, across the board--every state, both on and off the exchange, the works. This stung in quite a few counties across 11 different states, but the one which everyone is freaking out about is Tennessee...because there are 16 counties where Humana was the only carrier participating on the ACA exchange. Here's the list of Tennessee counties Humana is available in this year; note that there's an additional 14 counties where there's one other carrier available at the moment.

As noted a few weeks ago, Humana has already decided that regardless of what actions Donald Trump, Tom Price or Congressional Republicans end up doing (or not doing), they expect the 2018 individual market to be a big mess they want no part of...either on or off the exchanges:

...based on its initial analysis of data associated with the company’s healthcare exchange membership following the 2017 open enrollment period, Humana is seeing further signs of an unbalanced risk pool. Therefore, the company has decided that it cannot continue to offer this coverage for 2018. Through the remainder of 2017, Humana remains committed to serving its current members across 11 states where it offers Individual Commercial products. And, as it has done in the past, Humana will work closely with its state partners as it navigates this process.

Again, it's important to stress that Humana isn't just bailing on exchange participation, but to the best of my knowledge, they're pulling up stakes off-excahnge as well.

After their attempted merger with Aetna was roundly shot down by the federal government, insurance giant Humana issued a press release today with some major news:

Regarding the company’s individual commercial medical coverage (Individual Commercial), substantially all of which is offered on-exchange through the federal Marketplaces, Humana has worked over the past several years to address market and programmatic challenges in order to keep coverage options available wherever it could offer a viable product. This has included pursuing business changes, such as modifying networks, restructuring product offerings, reducing the company’s geographic footprint and increasing premiums.

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

Normally I post screenshots from the revised/updated SERFF filings and/or updates at RateReview.HealthCare.Gov, but it takes forever and I think I've more than established my credibility on this sort of thing, so forgive me for not doing so here. Besides, #OE4 is approaching so rapidly now that this entire project will become moot soon enough, as people start actually shopping around and finding out just what their premium changes will be for 2017.

The other reason I'm not too concerned about documenting the latest batch of updates/additional data is because in the end none of it is making much of a difference to the larger national average anyway; no matter how the individual carrier rates jump around in various states, the overall, national weighted average still seems to hover right around the 25% level.

Still, for the record, here's the latest...in four states (Iowa, Indiana, Maine & Tennessee) I've just updated the requested and/or approved average increases. In the other four (Massachusetts, Montana, North & South Dakota) I've added the approved rate hikes as well.

Things are looking pretty good for the ACA exchanges in states like Rhode Island, North Dakota and Massachusetts, where they're looking at single-digit rate hikes next year. However, they're looking pretty dire in states like Arizona, Montana and Oklahoma, where the average hikes are likely to be around 50% or higher for many people.

And then there's Tennessee, where Blue Cross Blue Shield asked for and received a 62% rate hike...but even so, just announced that they're dropping out of the individual market completely (both on and off exchange) in 30 counties throughout the state, in the Memphis, Knoxville and Nashville areas:

Bluecross BlueShield of Tennessee is pulling out of three regions in 2017 for their individual/marketplace plans.

As noted a couple of weeks ago, all three of the major insurance carriers participating in Tennessee's individual market ACA exchange asked for massive rate hikes this year, ranging from 44-62%. Blue Cross Blue Shield asked for 62% in the first place; Cigna and Humana resubmitted their original requests for higher ones.

Today, they received what they asked for from the state insurance commissioner (h/t to "M E" for the tip):

Tennessee's insurance regulator approved hefty rate increases for the three carriers on the Obamacare exchange in an attempt to stabilize the already-limited number of insurers in the state.

...BlueCross BlueShield of Tennessee is the only insurer to sell statewide and there was the possibility that Cigna and Humana would reduce their footprints or leave the market altogether.

I noted a few days ago that the Tennessee Dept. of Insurance is allowing 2 major carriers, Cigna and Humana, to re-submit filings for the 2017 individual market.

I noted at the time,

Cigna and Humana would have to revise their requests up to 50% apiece in order for the statewide average to end up hitting the 60% threshold, but that's not exactly a vote of confidence when it's already in the 56% range to begin with.

Well, neither one quite hit the 50% mark, but they both came close:

In its latest filing, Cigna is proposing an average 46 percent increase — double its first 23 percent increase request.

Humana, which requested a 29 percent average increase in June, is requesting an average 44.3 percent increase, according to a filing with the state regulators.

Here's what that looks like on the weighted average table:

Commenter "M E" has been doing a great job of revisiting the rate hike situation in states which I originally ran the numbers on back in May and June. Earlier today he brought the revised Arizona numbers to my attention, and now he's also noted that Tennessee (which was already facing the ugliest hike requests in the nation before I revised Arizona's average) will likely see their average hike requests jump up further in the days ahead:

In an effort to prevent more insurers from abandoning the Obamacare exchange in Tennessee, the state's insurance regulator is allowing health insurers refile 2017 rate requests by Aug. 12 after Cigna and Humana said their previously requested premium hikes were too low.

By my count, Tennessee has a total of 6 companies offering individual policies this year (Aetna, TRH, BCBS of TN, Cigna, "Freedom Life" (hah!) and Humana. UnitedHealthcare is dropping out next year, leaving at least 37,000 people to switch to a different policy (this is based on this article in the Tennessean, which claims that United currently has 15.76% of the On-exchange individual market in Tennessee). TN had 269,000 people select exchange-based QHPs during the 2016 open enrollment period. Assuming around 13% net attrition since then, that leaves around 234,000 current enrollees on the exchange. If United holds 15.76% of those, that's around 37,000 poeple.

OK, I made those last two up.

But yes, Clay County, TN Director of Schools Jerry Strong is indeed blaming the Affordable Care Act for his county's decision to pull the plug on the entire district in the middle of the school year:

The economy is so bad in Clay County, Tennessee that school is canceled indefinitely.

The decision to ebb budget concerns by shutting academic doors came down on Thursday when Clay County Director of Schools Jerry Strong quite literally decided to lock the doors of the county’s schools. He was particularly concerned with partially unfunded government mandates and what he believed to be the effects of Obamacare making it impossible to keep funds in the green.

(sigh) I noted, at the end of my "Transitional Plan" rant a few days ago, that in addition to the Kentucky Health CO-OP going belly up, there would likely be additional casualties announced over the next couple of weeks:

By contrast, the damage from the Risk Corridor program being crippled is specific, quantifiable and obvious: Company X lost $22 million in 2014; they were supposed to receive $20 million (or whatever) back in risk corridor reimbursements; the CMS dept. only has $2.5 million to pay them back with, period, so they have to eat the remaining $17.5 million loss until next year or the year after...if they're able to stick it out that long.

The Kentucky Health CO-OP couldn't stick it out that long...and it's possible that similar press releases may be forthcoming for a few other CO-OPs (and/or other smaller insurers) over the next week or so.

Sure enough, the Tennessee CO-OP, Community Health Alliance, has pulled the plug as well:

As we head into the final batch of states, it looks like the national weighted average rate increases, which had been hovering in the 11-12% range up until a week or so ago, are unfortunately starting to inch upwards, slammed by 20%+ averages out of South Dakota, Montana, West Virginia, Oklahoma and Utah. Lower average rate hikes out of Connecticut and Wyoming have also been announced, but the other 5 states more than cancelled those two out.

And now you can add Tennessee to the mix. Starting with Louise Norris' exchange-only data (which comes in at a 33% average hike), I've also plugged in additional off-exchange individual market numbers to come up with what looks like an overall average rate hike of around 28.3%:

Well, score one for the Koch brothers:

In December, Tennessee Gov. Bill Haslam, a Republican, got the deal he wanted from the Obama administration: Tennessee would accept more than $1 billion in federal funding to expand Medicaid, as allowed for in the Affordable Care Act, but Obama aides would allow Haslam to essentially write staunchly conservative ideas into the program's rules for the state. He dubbed the reformed Medicaid program "Insure Tennessee."

But the state's chapter of Americans for Prosperity, the national conservative group whose foundation is chaired by controversial billionaire David Koch, argued Haslam was just trying to trick conservatives into implementing Obamacare in their state by giving it a new name. AFP campaigned aggressively Haslam's plans for the next six weeks, even running radio ads blasting GOP state legislators who said they might vote for it.

On Wednesday, Haslam's bill died in a committee of the Tennessee state senate. The vote was one of the clearest illustrations of the increasing power of AFP and other conservative groups funded in part by the Koch brothers.

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