Vermont is the 4th state to post their initial 2018 rate filings. Vermont has a couple of unusual policies re. their healthcare market: First, while they do technically have an off-exchange individual market, those policies are all fully ACA-compliant QHPs and are tracked exactly the same as on-exchange QHPs, meaning this dashboard report from February includes just about all of their individual market enrollees: 28,775 on exchange + 5,662 off-exchange, for a total of 34,437 ACA-compliant enrollees. Vermont didn't allow transitional plans, so aside from an unknown number still enrolled in grandfathered plans, that should represent their entire individual market.
As I've noted before, until today, there was one state which I had no OE4 data for whatsoever: Vermont (which is ironic given their historic support of healthcare reform, including Sen. Bernie Sanders). This blank has been filled in by today's supplemental CMS/ASPE report: 29,021 QHP selections as of 12/24, which is actually quite a bit higher than I expected for the state (my target for VT is only 30,000 total through 1/31).
Last month I noted (well, after Louise Norris called my attention to it) that after 2 years of restricting all individual market enrollments to their still-buggy ACA exchange, the state of Vermont actually reversed this policy for 2016 by allowing individuals to enroll in ACA-compliant policies directly through the carriers after all.
This actually goes against the recommendations I just wrote about yesterday, leaving the District of Columbia as the only other exchange to require all indy plans to run through it), but given how many technical problems Vermont seems to still be having with their platform, I can understand them allowing direct enrollment for the time being. I stand by my recommendation that every state should eventually move everything onto the exchange in the future, however.
I noted back in February that Vermont Health Connect, VT's ACA exchange, has remained essentially silent since last fall, issuing only 2 press releases since Open Enrollment started last November (one of which was about a new plan comparison tool, the other of which was about some sort of Medicaid-related dealine). In other words, they haven't publicized their 2016 enrollment numbers whatsoever...the only reason I have data for VT at all is thanks to the official ASPE reports from the HHS Dept. This is a stunning 180º turnaround from 2015, when they were issuing detailed reports on a regular basis.
As I noted last week, Your Health Idaho has released their final official OE3 number. I had previously noted that there were only 8 states in which the exchanges appeared to have performed worse on private policy enrollment in 2016 than they did in 2015, and that most of those had special circumstances:
Over the past few months, I've ranted repeatedly about what a stupid, short-sighted, petty move it is of Kentucky Governor Matt Bevin to shut down the kynect ACA exchange, for a variety of reasons...most of which center around the fact that the kynect exchange has been operating smoothly since the moment it launched in October 2013. In other words, there's very little reason to kill kynect, and plenty of reasons to keep it operational.
If you take a look at the State-by-State chart, you'll notice that in addition to a few clarifications here and there, there are 5 states (well, 4 states +DC) all the way at the bottom labelled "NO DATA YET".
California insists, just like last year, on doing this weird thing where they release the number of new enrollees who have signed up on a fairly regular basis, but the number of renewals by current enrollees is kept a secret all the way into January. I have no idea why they do that, and it's pretty important given that we're likely talking about somewhere between 1.0 - 1.3 million people here.
On the other hand, at least they've posted data on their new additions. DC, Idaho, Kentucky, New York and Vermont haven't even done that much as of this writing.
As it happens, at least two other state-based exchanges have done so as well:
COVERED CALIFORNIA: It's pretty obscure for the moment, but if you click the "Shop & Compare Tool" link at the lower left-hand corner of the CoveredCA website, you'll be given the option to shop around for 2016 plans (you can also choose 2015 plans in case you've had a qualifying life change and need coverage for the last 2 months of this year, or even 2014 plans if you still need that information for tax purposes or whatever):
Gov. Shumlin Updates on Vermont Health Connect Progress
MONTPELIER – Gov. Peter Shumlin, representatives from Vermont’s insurance carriers, and officials and staff from Vermont Health Connect (VHC) gathered today to update on the health insurance marketplace’s progress. The Governor announced that the technology upgrade necessary for a smooth open enrollment has been delivered and tested and will be deployed starting this evening; the backlog of change of circumstance cases has been cleared; VHC is now operating at a vastly improved customer service level for change requests; and customers will be able to report many changes online starting Monday. Meeting those milestones is consistent with the schedule laid out by the Governor in March 2015 and in legislation passed later in the spring.
In today's speech at the Howard University College of Medicine, HHS Secretary Sylvia Burwell started ramping things up for the 2016 Open Enrollment Season (which I'm gonna designate #ACA2016 unless someone else comes up with something better) by dropping some data points.
Among these was this one:
Almost half of the uninsured individuals who are likely eligible for Marketplace plans are between the ages of 18 and 34.
This is really important, because only about 28% of those who enrolled in exchange-based policies this year fall into the 18-34 range, which is a problem from an actuarial/risk pool perspective. Younger people are generally healthier, so the insurance companies prefer to have a higher percentage of them in their risk pools in order to help keep premiums/deductibles from increasing too quickly.
If "almost half" of the 10.5 million uninsured people eligible for the ACA exchanges are in the 18-34 range, that's roughly 5 million young adults who the exchanges need to target.
Vermont was one of the earliest states to report their requested rate hikes back in mid-May. Due to Vermont's small size (both in total population as well as insurance providers...there's only two of them even operating on the individual markets), as well as their unique law requiring that all individual policies be purchased through the ACA exchange, they were also one of the easiest to calculate.
In addition, as far as I can tell, in Vermont, both the individual and small group markets are considered part of the same rate pool, although the market share differences between the two still resulted in slightly different weighted averages: 7.8% for the individual market, 8.1% for the small group market. These were slightly revised to 8.0% and 8.3% just prior to the review/approval process.
The 2016 rate requests are popping up all over the place now...here's Vermont:
Blue Cross Blue Shield of VT is requesting avg. 8.38% increase for 31,147 individual exchange enrollees and 35,903 small business (small group) enrollees.
HOWEVER, it's important to bear in mind that this average a) ranges from 4.7% to 14.3% depending on the type of policy, and they seem to have mixed both individual and small group enrollments together (first time I've seen that so far). Here's the distribution; I'm not sure I understand the 2,964-enrollee difference between the totals:
As you can see, about 1.6% of enrollees would see an increase of 5% or less, while 32% would see a 10-15% increase, with the remaining 66% between 5-10%.
The impending King v. Burwell Supreme Court decision will cast an even larger shadow over the ACA over the next 2 months (the decision is expected to be announced in June), as exchanges in 6 of the 14 states running their own (State-Based Marketplaces, or SBMs) are at risk of either being abandoned, dissolved or otherwise moved over to the federally-run Healthcare.Gov exchange:
The federal government is threatening to take over Hawaii's health insurance exchange within months and has restricted grant money to support operations of the Hawaii Health Connector.
Jeff Kissel, the Connector's executive director, told lawmakers at a briefing Thursday that if the exchange created by the Affordable Care Act does not get state funding soon, the federal government will abolish Hawaii's marketplace and run it directly.