2018 MIDTERM ELECTION

Time: D H M S

Texas

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the concerns regarding up to 32 million people potentially losing their healthcare coverage in the event the ACA is repealed: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.

Oh, wait; that's a scarlet "S".

Roughly a million Texans with government-subsidized health coverage could see a new label on their health insurance cards, and critics say the designation is akin to a “scarlet letter.”

But instead of Hester Prynne’s infamous “A,” insurance cards for Texans with coverage under the federal Affordable Care Act would bear the letter “S,” for subsidy.

Supporters of House Bill 1514 by state Rep. J.D. Sheffield, R-Gatesville, say it’s necessary to standardize insurance cards and clarify the type of health coverage a patient has.

Needless to say, I'm appalled.

Joan McCarter over at Daily Kos has already given a proper takedown of this utterly unnecessary & shameful bill.

UPDATE 5/27/15: Well, the Texas Senate has now passed the same bill, although they've slightly modified it:

After the one-two punches of both Rhode Island and Vermont moving in exactly the wrong direction (at least before the King v. Burwell SCOTUS decision is announced this summer), my jaw nearly dropped when I read this story out of Texas, of all states:

LEGISLATURE: Bills would create Texas' own health benefit exchange

AUSTIN -- On Wednesday, State Rep. Chris Turner (HD 101-Grand Prairie) filed two bills, HB 818 and HB 817, both creating a state health benefit exchange.

This is an excellent overview of how healthcare pundits, politicos, reporters and industry folks are keeping a very close eye on the ACA exchanges this weekend, as the December 15th deadline for January coverage approaches (well, for most states, that is; 6 states now have deadlines later than the 15th). It's well worth a read, as it goes into the whole "manual renewal" vs. "autorenewal" issue and a whole mess of other stuff.

However, towards the end are two additional data points:

CMS officials, including Marketplace CEO Kevin Counihan have been reassuring about auto-enrollment, said Martin Hickey, CEO of New Mexico’s co-op health plan. “It’s a stressor, but I haven’t seen him biting his fingernails,” Hickey said of Counihan. “But you never know.” His own health plan has had 3,ooo people sign up as of Dec. 10 through HealthCare.gov and the pace is picking up.

A reader forwarded this to me; I ran a search for the organization they referred to and sure enough, it's legit:

Email today from Texas Well and Healthy that might suggest another one of those "we have to craft a uniquely TX solution for a uniquely TX problem because Obamacare sucks" deal. Copy follows...

County Leaders Call for Insurance Solution as Texas Senate Commitee Discusses Alternatives to Medicaid Expansion

Our state leaders may be moving slow on health care, but local leaders are giving them a nudge in the right direction.

Leaders of six of the state's largest counties -- ranging from Harris County's Republican Judge Emmett to Dallas County's Democratic Judge Jenkins -- have joined together to call on the legislature to find a "uniquely Texas solution" to covering uninsured low-wage workers.

The county leaders wrote to the legislature as the Senate Health and Human Services Committee met to discuss Texas alternatives to Medicaid expansion.

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