END OF 2018 OPEN ENROLLMENT PERIOD (42 states)

Time: D H M S

Utah

Up until a week ago, the possibility of Donald Trump pulling the plug on Cost Sharing Reduction reimbursement payments was a looming threat every day. While it hadn't actually happened yet, most of the state insurance commissioners and/or insurance carriers themselves saw the potential writing on the wall and priced their 2018 premiums accordingly (or at the very least prepared two different sets of rate filings to cover either contingency).

A few spread the extra CSR load across all policies, both on and off the exchange. This seems like the "fairest" way of handling things on the surface, but is actually the worst way to do so, because it hurts all unsubsidized enrollees no matter what they choose for 2018 and can even make things slightly worse for some subsidized enrollees in Gold or Platinum plans.

Protect Our Care is a healthcare advocacy coalition created last December to help fight back against the GOP's attempts to repeal, sabotage and otherwise undermine the Affordable Care Act. This morning they released a report which compiled the approved 2018 individual market rate increases across over two dozen states.

Needless to say, they found that the vast majority of the state insurance regulators and/or carriers themselves are pinning a large chunk (and in some cases, nearly all) of the rate hikes for next year specifically on Trump administration sabotage efforts...primarily uncertainty over CSR payment reimbursements and, to a lesser extent, uncertainty over enforcement of the individual mandate penalty.

Utah has also finally released their requested 2018 individual market rate increases. There are six carriers offering individual policies next year, but only 2 of them are participating on the ACA exchange (and the 4 off-exchange carriers hold less than 4% of the total market combined). In fact, two of the off-exchange-only carriers are barely participating at all: BridgeSpan has only 8 enrollees, while "National Foundation" (a "phantom carrier" which also goes by "Freedom Life" in other states) once again supposedly only has a single "enrollee". Molina has a few hundred off-exchange enrollees, but the bulk of their 70,000-person membership are in exchange-based policies, and they're dropping off the exchange next year, so those 70K will have to choose from one of the two remaining exchange carriers: SelectHealth and the University of Utah.

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:

When I plugged the numbers in for Utah way back in June, I came up with a weighted average request of around 30.7%. 

Louise Norris gave me a heads up that the approved rates were in for UT, and sure enough she's correct. Not a whole lot to report, however; most of the requests were approved as is, with only minor modifications; the approved average is slightly higher:

UPDATE 6/22/16: I've been informed that there was a coding glitch with Utah's website which prevented several carrier rate filings from being listed. I've gone back and plugged in the additional carriers, which account for about 32,000 more Utah residents...but which only moves the weighted average slightly, since Molina's request is fairly close to the 30% average I already had estimated.

This leaves around 93K unaccounted for. Some of them are presumably enrolled via University of Utah plans; U of U's enrollment numbers are redacted, and while the Utah site claims a 0% rate hike, the RR.HC.gov database lists it as 4.47%.

Also, as far as I can tell, "American Medical Security Life Insurance Co." is a branding for UnitedHealthcare, which should clear up that confusion.

Back in mid-April, I posted the UnitedHealthcare State Dropout Odometer, which tracked exactly which of the 34 states which UnitedHealthcare is currently offering individual market policies in this year they'd drop out of for 2017. Instead of simply stating "we're sticking around in these states and dropping out of the rest", United decided to dole the pain out gradually, with states announcing their departure one by one over several weeks. For quite awhile, I knew that they were sticking around Nevada, New York and Virginia, with another half-dozen states in limbo status.

Today, according to the Chicago Tribune and the Minnesota Star Tribune, it looks like those three are it: They'll still be available in those 3 states, but are pulling out of the other 31 (including California, where they only have around 1,200 current enrollees via the exchange anyway). OK, that sucks, but we kind of knew about this already; it's old news for the most part.

(sigh) Details to follow, but for the moment...

Utah insurance department confirms Arches will be the 10th health co-op to wind down. (cc: @charles_gaba)

— Adam Cancryn (@adamcancryn) October 27, 2015

@charles_gaba Yeah, insurance dept. just confirmed. Shooould be the last one, but we'll see

— Adam Cancryn (@adamcancryn) October 27, 2015

UPDATE: OK, here's the actual press release from the Utah Insurance Department, not that there's anything new here:

Not much else to add here:

Republican lawmakers in Utah voted in a closed-door meeting on Tuesday to shelve a plan to provide health care for about 95,000 of the state’s poor.

After months of negotiations earlier this year, the Health Reform Task Force unveiled a scaled down of the Healthy Utah plan for Medicaid expansion called Utah Access Plus. Under the new plan, the federal government would pick up about $450 million. An additional $50 million would be funded by taxes on doctors, hospitals, pharmaceutical companies and other medical providers.

On Tuesday, the Republican caucus gathered behind closed doors to determine whether it would allow the new proposal to move forward. According to KUER, lawmakers decided to kill the plan, leaving the future of Medicaid expansion uncertain in Utah.

Strike That: Apparently the Republicans immediately followed up crushing the spirits of 95,000 of their fellow Utahns by...eating birthday cake.

Over at HealthInsurance.org, Louise Norris has done her usual excellent job of summarizing the enrollment/rate/exchange participation situation for another state, Utah. As she notes, in addition to the companies which operated on the Utah ACA exchange this year, one more "mystery" company is expected to join in 2016. Of course, Louise only focuses on the companies actually operating on the exchange, while I'm looking at the entire ACA-compliant individual market state-wide (because the risk pool includes off-exchange policies as well).

Fortunately, Utah has a fairly comprehensive rate review database with an easy-to-use lookup feature. Unfortunately, a few of the entries don't quite jibe with HHS's RateReview website. Most notably, the HHS site claims that Arches Mutual Insurance has 2 filings from the same date: One requesting a jaw-dropping 58% hike, the other for a slightly less-insane 46.65% increase, neither of which includes the actual number of covered lives:

A shout-out to Dan Diamond for this unexpected Friday evening heads' up:

Breakthrough — Utah GOP leaders reach a deal on Medicaid expansion

Republican leaders have agreed to a broad, conceptual framework for expanding Medicaid to insure tens of thousands of low-income Utahns with a plan that would call on medical providers to pay for the new health coverage.

The so-called Gang of Six — Gov. Gary Herbert, Lt. Gov. Spencer Cox, Senate President Wayne Niederhauser, House Speaker Greg Hughes, House Majority Leader Jim Dunnigan and Sen. Brian Shiozawa — huddled this week constructing the skeleton of a new Medicaid plan to replace the governor's Healthy Utah and the House's Utah Cares proposals.

On Friday, they announced their agreement, saying it was sustainable and would protect other key areas of the budget.

I have a ton of ACA-related stories cluttering up my in-box again; here's some of the more interesting ones, all regarding ACA Medicaid Expansion:

MICHIGAN:

For months now, I've been a bit obsessed with figuring out how my home state's Medicaid expansion enrollment has managed to reach as high as 21% more people than were supposedly even eligible for the program. Estimates last year ranged from 477,000 - 500,000, yet enrollment in Healthy Michigan (Gov. Snyder's name for Obamacare Medicaid Expansion) currently sits at a whopping 579K, less than 1 year into the program.

Add Utah to the list of GOP-run states changing their tune on Obamacare:

Gov. Gary Herbert announced Thursday that after months of negotiations, he has reached a final agreement with the Obama administration on his novel alternative to expanding Medicaid.

"They are giving us more flexibility than has been given to any other state in America. We are breaking some new ground," Herbert announced in his monthly press conference on KUED.

Herbert said he soon will send to the Obama administration a letter outlining the agreement they’ve reached on Utah’s alternative, his Healthy Utah plan.

The deal would help low-income Utahns earning up to 138 percent of the federal poverty level who are not covered by Medicaid buy private health insurance plans.

From the sounds of it, it looks like this will be set up along the lines of the Arkansas "private option" program, which basically amounts to using Medicaid funding to cover practically 100% of the cost of private QHPs.

There's been a lot of fuss made about 2015 ACA exchange premium rates not being available at Healthcare.Gov until after the election. The presumption, of course, is that this is being done for political reasons. While this may be true, it could also simply be that there's a lot of different policy figures to plug into the federal system, and some states haven't even finalized their rates yet.

That being said, residents of some states can check out the 2015 premiums now and compare them against their current premium:

IDAHO: Idaho is the only state moving from HC.gov to their own exchange. Idaho residents can check out their 2015 rates directly via the state exchange site.

CALIFORNIA: CoveredCA has 2015 rates available right now as well.

Of course it would've been even more "win, win, win all around" if they'd just done this 9 months ago, but I'll take it...

The Obama administration has agreed in concept to Utah’s novel alternative to expanding Medicaid, including the notion that able-bodied people who get insurance subsidies should accept the state’s help with finding work, Gov. Gary Herbert said late Tuesday.

The governor said after a meeting with Sylvia Burwell, secretary of the Department of Health and Human Services, that a final agreement is two or three weeks away.

HHS did not agree that insurance subsidies would be contingent on recipients holding a job or looking for work, but the agency did agree that employment can be a goal of Utah’s program, Healthy Utah.

"It’s a win, win, win all the way around," the governor said, describing the negotiations as resulting in federal approval of 95 percent of his Healthy Utah plan.

The estimate of how many Utahns would be eligible ranges from 54K - 75K; I have it down as 61K, right in the middle.

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