END OF 2018 OPEN ENROLLMENT PERIOD (41 states)

Time: D H M S

Texas

And finally...

I've saved Texas for last because, frankly, I haven't been able to make heads or tails out of their actual average rate increases for next year (and unlike smaller states which might not move the needle on the national average anyway, Texas has one of the largest populations in the country, so a substantial error here can also impact the national numbers significantly).

Back in early August, I pieced together a rough average of the requested rate increases for the Lone Star State of around 20% if CSR payments are made or 32.5% if they aren't:

 

Maybe Tom Price is trying to take the heat off of his chartered jet shenanigans, but whatever the reason, this is welcome news:

CMS Announces Special Enrollment Periods for Americans Impacted by Recent Hurricanes
Agency provides special open enrollment periods for 2017 Medicare and Exchange coverage

As a result of Hurricanes Harvey, Irma, and Maria, the Centers for Medicare & Medicaid Services (CMS) will make available special enrollment periods for all Medicare beneficiaries and certain individuals seeking health plans offered through the Federal Health Insurance Exchange. This important step gives these individuals and families who have been impacted by the hurricanes the opportunity to change their Medicare health and prescription drug plans and gain access to health coverage on the Exchange immediately if eligible for a special enrollment period.

On Sunday, HHS Secretary Tom Price officially called it in Texas:

Health and Human Services Secretary Tom Price, MD, declared a public health emergency in Texas on Saturday as Hurricane Harvey was pounding the state's coast.

Harvey made landfall late Friday night with winds topping 130 mph. Forecasts called for the storm to hover over the state for 5 days or more, possibly drenching some areas with as much as 50 inches of rain. Hundreds of thousands were without power and the National Weather Service said parts of Texas could be "uninhabitable for weeks or months."

"Many Medicare beneficiaries have been evacuated to neighboring communities where receiving hospitals and nursing homes may have no health care records, information on current health status or even verification of the person's status as a Medicare beneficiary. Due to the emergency declaration and other actions taken by HHS, CMS is able to waive certain documentation requirements to help ensure facilities can deliver care," an HHS statement read.

Whew! OK, Texas was a bear for obvious reasons...13 different carriers (well, 12 really...Centene is new to their market). Several more are dropping out (Aetna, Allegian, Cigna, Humana, Memorial Hermann and Prominence), but suposedly theyonly have around 64,000 enrollees in TX combined. Texas's total individual market is actually closer to 1.6 million, so I'm obvoiusly missing a big chunk of enrollees below (and before my regular commenters say it: Yes, I'm sure the off-exchange TX indy market has shrunk this year, but I find it hard to believe it's shrunk by over 60% already).

Anyway, I've managed to plug in one hard request percent for each carrier--the FULL Trump Tax for 3 of them, the NO/PARTIAL Trump Tax for most. In Vista's case, they're off-exchange only so the CSR issue isn't a factor anyway. Unfortunately, I can't seem to find the enrollment number for Community Health Choice, so I don't know what their share of the market is, which could make a big difference if they have high enrollment. I've plugged in a flat 100,000 enrollees for the moment, but will change that if I'm able to track the actual number down.

Earlier today I noted that a bunch of Republican--yes, Republican--governors have chimed in in defense of the Affordable Care Act (or, at least the Medicaid expansion provision). They had a big powwow with GOP Congressional big shots to air their case.

Well, Republican U.S. Senator John Cornyn, the Majority Senate Whip (and therefore one of the biggest shots in the Senate) shot off quite a promise about the concerns regarding up to 32 million people potentially losing their healthcare coverage in the event the ACA is repealed:

One of the top concerns is what will happen to individuals who became eligible for Medicaid with its expansion under Obamacare. The Senate's No. 2 Republican, however, promised that no one who got coverage under Medicaid expansion will lose it.

When Conrnyn was asked if he was concerned about people who've benefited from Medicaid expansion losing coverage, he said it was a shared concern.

(sigh) OK, after doing this for Michigan earlier today, I said that I wasn't gonna do this for every state, and I'm not...but the irony is that the 19 non-expansion states are actually easier to compile this data for than the expansion states...because you can't rip away healthcare from someone you never provided it to in the first place. Anyway, someone requested that I do a county-level estimate of how many people would likely lose their healthcare coverage in Texas under a full repeal of the Affordable Care Act, so here it is.

Last week I noted that with 41 states accounted for and the 2017 Open Enrollment Period quickly bearing down on everyone, it was time to pull the plug on my 2017 Average Rate Hike project and move on. I had come up with an overall national weighted unsubsidized average rate increase of around 25% for ACA-compliant individual market plans.

However, I also noted that I'd make sure to fill in the approved rates for the remaining 10 states as they came in, for completeness sake...and today, thanks to the HHS Dept. cutting the ribbon on 2017 Window Shopping at HealthCare.Gov, I've also been able to fill in the blanks for five of the remaining states all in one shot (the other five remain elusive).

Thanks to Thiago Santiro in the comments for this heads up:

Blue Cross Blue Shield of Texas will be the sole player in the ACA marketplace here, making Tarrant County the largest metro area in the state down to one participant.

Four of the previous insurers in the county — Aetna, Scott & White, Cigna and UnitedHealth — each confirmed they have pulled out of the ACA marketplace throughout the state.

According to my original estimates from back in May, Cigna only has around 19,000 people enrolled in individual market plans to begin with: 14,000 via Cigna Health & Life Insurance, 5,000 via Cigna Healthcare of Texas. However...

...Cigna also will continue to offer individual plans off the marketplace, according to spokesman Joe Mondy.

Thanks again to commenter "M E" for finding this Business Insider article in which health insurance startup Oscar Insurance Co. has announced that they're pulling out of the ACA exchange completely in New Jersey, and out of the Dallas market specifically in Texas...while also expanding into San Francisco next year:

According to a release from the company on Tuesday, the firm will no longer offer individual market plans through the Affordable Care Act in Dallas, Texas, and New Jersey.

..."We hope to return to these markets as we carry on with our mission to change healthcare in the US."

The "we hope to return" part suggests that Oscar will continue to be available off the exchange in New Jersey, since completely pulling out of a state means a carrier has to wait at least 5 years before re-entering. So...there's that, anyway.

...Oscar currently covers 7,000 people in Dallas and 26,000 in New Jersey.

Hoo, boy. Here comes the pain.

Last year, the Texas ACA-compliant individual market carriers requested an average rate hike of around 16%, although it was a pretty fuzzy guesstimate since I couldn't track down the average rate hikes for about 25% of the market other than knowing that whatever it was, it was under 10%.

This year, the good news is that CMS has started posting all rate change requests whether over or under 10%, making it easier to fill in some of the data. The bad news is that 3 of the 19 carriers offering individual policies next year redacted any data giving a clue as to what their current enrollment numbers are: CHRISTUS, Community First and Oscar Insurance.

The other 16 carriers did provide those numbers pretty clearly (except for Sendero, which only gave a projection of "member months" which I had to divide by 12 to get a rough enrollment estimate).

As I've noted before, one of the biggest hurdles to overcome when considering moving to Single Payer healthcare is that at least a half a million people currently work directly for health insurance carriers, plus (I'm guessing) another couple million in directly related services. While I do support moving to SP eventually, any plan which replaces the current private insurance industry would have to also take into account what would happen to those people.

IMPORTANT: See this detailed explanation of how I've come up with the following estimated maximum weighted average rate increase request for Texas.

UPDATE 8/4/15: Revised table to display maximumlikely and minimum statewide average increase requests:

Assuming you've read through the explanation linked to above, here's my best estimate of the maximum possible rate increase requests for the Texas individual market:

Thanks to Don Kramer for the heads up:

News Alert – July 23, 2015
Individual/Consumer Markets
What to Expect for 2106 Open Enrollment Plans

On Monday, the Texas Department of Insurance gave Blue Cross and Blue Shield of Texas (BCBSTX) the clearance to announce a change in retail product offerings for 2016. We wanted to share this information with you first.

...There are some changes in the plans we intend to offer in 2016. Most significantly, we won’t be offering our Blue Choice PPO insurance plans for our under 65 block of business going forward.

We intend to offer other products, on and off the Marketplace. A new product has been filed that we believe will give you a flexible choice for your clients. We will be able to share information about that product if and when it is approved by the Centers for Medicare & Medicaid Services (CMS) closer to open enrollment.

...Currently, we have about 367,000 individual Texas members who will have their PPO plan discontinued in 2016. This number fluctuates monthly.

I think the headline accurately depicts former Texas Governor and current Presidential Candidate Rick "Do The Glasses Make Me Look Smarter?" Perry's defense of the appallingly high uninsured rate in Texas during his 14-year tenure as chief executive of the state.

Perry appeared on FOX News Sunday with Chris Wallace this morning, and for the 2nd week in a row, Wallace actually acted like a Real Journalist® instead of a GOP/FOX hack and pressed Perry with some solid questions regarding the sorry state of healthcare coverage in his state.

Of the 6.5 million people who would lose their federal tax credits, and almost certainly their healthcare coverage (completely apart from the additional 6.5 million who would have an economic boulder dropped on them indirectly) in the event of a King v. Burwell plaintiff win, over 1/3 live in just two states: Florida and Texas. 1.34 million Floridians and 846,000 Texans would be be among the direct casualties...close to 2.2 million between the two of them.

Given that both are completely run by off-the-rails batcrap-insane Republicans in the House, Senate and Governor's office, it's safe to say that you can expect a LOT of stories like the following from the Sunshine and Lone Star states.

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