Texas

Gold Bars

NOTE: This is an updated version of a post from a couple of months ago. Since then, there's been a MASSIVELY important development: The passage of the American Rescue Plan, which includes a dramatic upgrade in ACA subsidies for not only the millions of people already receiving them, but for millions more who didn't previously qualify for financial assistance.

Much has been written by myself and others (especially the Kaiser Family Foundation) about the fact that millions of uninsured Americans are eligible for ZERO PREMIUM Bronze ACA healthcare policies.

I say "Zero Premium" instead of "Free" because there's still deductibles and co-pays involved, although all ACA plans also include a long list of free preventative services from physicals and blood screenings to mammograms and immunizations with no deductible or co-pay involved.

Much has been written by myself and others (especially the Kaiser Family Foundation) about the fact that millions of uninsured Americans are eligible for ZERO PREMIUM Bronze ACA healthcare policies.

I say "Zero Premium" instead of "Free" because there's still deductibles and co-pays involved, although all ACA plans also include a long list of free preventative services from physicals and blood screenings to mammograms and immunizations with no deductible or co-pay involved.

If you have a fairly healthy year, you really could go the entire year without paying a dime in healthcare costs while still taking advantage of many of these free services, and also having the peace of mind that in a worst-case scenario, at least you wouldn't go bankrupt. Not perfect, but a lot better than going bare especially since you wouldn't pay a dime in premiums.

 CMS Offers Comprehensive Support to the State of Texas to Combat Winter Storm 

The Centers for Medicare & Medicaid Services (CMS) announced today that efforts are underway to support Texas in response to severe winter storms that have affected the state over the past several days.  On February 17, 2021, Health and Human Services Acting Secretary Norris Cochran declared a public health emergency (PHE) for Texas retroactive to February 11, 2021. CMS is working to ensure hospitals and other facilities can continue operations and provide access to care despite the effects of the storm. 

Below are key administrative actions CMS is taking in response to the PHE declared in Texas:

Waivers and Flexibilities for Hospitals and other Healthcare Facilities: CMS has already waived many Medicare, Medicaid and CHIP requirements for facilities because of the pandemic. 

Back in July I posted a partial look at the preliminary 2021 ACA market landscape for Texas. I only had data for about 1/3 of the carriers at the time, so it was more of an overview than anything.

Now I have most of the data needed to analyze the individual market for 2021: Assuming no major changes in the approved rates, carriers are averaging around a 7.4% premium increase next year. This is actually unusually high for 2021 so far...other states are averaging less than 2% overall.

Most of the rate hike seems to be caused by Celtic/Ambetter ("Superior Health Plan"), which holds 1/3 of the entire market and is raising rates by nearly 12%. Blue Cross Blue Shield, which has another 36% market share, is only raising rates 3%, while the third and fourth largest carriers in the market, Molina and Oscar, are raising rates by 5.3% and 14.7% respectively.

There's also a couple of misleading numbers--both divisions of "Scott & White" are massively DROPPING their premiums for 2021, by 33% and 54%...but they have fewer than 2,000 people enrolled total to begin with; make of that what you will.

Unfortunately, it looks like only some of the 2021 ACA individual market premium rate filings have been uploaded to the SERFF database as of today, so I'm unable to calculate anything even close to an accurate weighted average. There are, however, several noteworthy items on the TX market:

Note: I've been distracted by my county-level COVID19 tracking project for the past couple of weeks, so I'm posting a series of entries on various ACA/healthcare policy developments which I've missed along the way.

I've missed a lot of stuff while busy diving down the rabbit hole of my county-level COVID-19 spreadsheet tracking project. This happened last week so I guess it's old news by now, but it's still both a sign of the times as well as of how hypocritical so many Republicans are about the Affordable Care Act:

Sen. John Cornyn (R-Texas) sat down for an interview yesterday with PBS Austin's Judy Maggio, who raised concerns about "holes in the safety nets" affecting many Texans. Specifically, the host noted that as more people lose their jobs during the pandemic, they're also losing their health security. Maggio asked the Senate Republican about possible federal efforts for those who are now "wondering what they're going to do for health insurance."

Cornyn's response was ... unexpected.

After a TON of tedious work porting data over into my county-level COVID-19 tracking spreadsheet, I've completed charts breaking out confirmed cases in two additional states: Minnesota and Texas.

Minnesota was an obvious choice, given that it was the closest swing state won by Donald Trump. Texas may seem like an unusual choice given that it's considered to be a solid red state and that it hasn't seen the type of ugly outbreak of COVID-19 (yet) that several other states have, but I happened to discover that unlike states like Florida and Georgia, Texas's Health Dept. dashboard makes it quite easy to download the historic case and fatality data I need to compile these charts, so I decided to go for it. The results in both states are interesting for different reasons.

Back in mid-August, I plugged in the preliminary 2020 individual market rate change requests for unsubsidized enrollees in Texas. Unfortunately, at the time I only had hard enrollment data for some of the carriers, which meant I could only run a "semi-weighted" statewide average, which came in at +0.8%.

Since then, I've managed to find the enrollment data for the rest of the carriers as well...and yesterday CMS posted the final, approved 2020 rate changes, allowing me to run the complete, final, fully-weighted average. In the end rates in Texas are dropping by 1.4%:

MLR rebate payments for 2018 are being sent out to enrollees even as I type this. The data for 2018 MLR rebates won't be officially posted for another month or so, but I've managed to acquire it early, and after a lot of number-crunching the data, I've recompiled it into an easy-to-read format.

But that's not all! In addition to the actual 2018 MLR rebates, I've gone one step further and have taken an early crack at trying to figure out what 2019 MLR rebates might end up looking like next year (for the Individual Market only). In order to do this, I had to make several very large assumptions:

At long last, I've completed my analysis of the preliminary 2020 rate filings for ACA-compliant individual market policies across all 50 states (+DC)! in most cases I've also included the small group market, although with far less documentation for those.

Texas, understandably enough, has the third largest individual market in the country after California and Florida, at somewhere around 1.27 million enrollees (they had around 990,000 on-exchange enrollees; I'm pretty sure around 75% of the market is on-exchange these days).

There's ten carriers offering ACA policies on the individual market in Texas, and fifteen participating in the small group market. Unfortunately, most of the rate filings are redacted or missing data altogether (again), so I was only able to cobble together hard enrollment data for half the Indy market carriers, comprising just 15% of the statewide market. I've run an unweighted average for the other five carriers, and blended that with the first five for a semi-weighted average rate hike of just 0.8% overall.

I know this is an imperfect way of doing it, but it's the best I can do at the moment. I hope to have more complete data once the approved filings are made available.

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