Vermont

A few days ago I noted that the Maryland Health Connection has officially launched window shopping for the 2016 open enrollment period (#OE3).

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):

YOUR HEALTH IDAHO:

Anonymously Shop and Compare Health and Dental Plans on Your Health Idaho

Presented without comment:

FOR IMMEDIATE RELEASE

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.

MARYLAND:

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.

Yesterday the state regulators announced the final approved rates for both BCBSVT and MVP...and lo and behold, they've shaved off several points in both the individual and small group markets:

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.

Now that the King v. Burwell Supreme Court oral arguments are out of the way (with radio silence expected until they announce the decision sometime in June) , the next Big Development to keep an eye on ACA-wise is...Tax Season! There will be plenty of stories about how many people have to pay back some/all of their 2014 tax credits, how many will receive additional tax credits...and, most germane to this site, how many additional people enroll via the exchanges to avoid having to pay (most) of the higher tax penalty next year for not being covered in 2015 during the Tax Filing Season Special Enrollment Period (SEP), or #ACATaxTime as I prefer to call it.

This isn't an exact apples-to-apples comparison, since the Massachusetts number includes the "overtime" extension period while the other 5 states only run through 2/15/15, but I thought it would be useful to see how the 6 exchanges which had widespread technical issues last year fared this time around. Obviously  other states like Washington and California had some snafus, but these are the ones which were seriously hosed last year to the point of requiring massive overhauls or which were completely scrapped in favor of a new platform (I'm not including HC.gov itself here since everyone already knows what massive technical improvements they've made).

The chart below refers specifically to QHP selections only (whether paid or not), and compares the 2015 open enrollment period (11/15/14 - 2/15/15...or 2/26 in the case of MA) against the 2014 open enrollment period (10/1/13 - 4/19/14). I've also included some notes for context.

WIth the DC and Vermont updates this evening, there are now only 4 states which haven't brought their enrollment data up through the end of open enrollment: CO, CT, ID and KY:

Vermont Health Connect Open Enrollment and Renewal Update

The following numbers are up-to-date as of 11:59pm Sunday, February 15, 2015.

New Vermont Health Connect Customers

15,422 individuals have checked out a 2015 health plan. This includes 6,211 individuals in Qualified Health Plans (private health insurance) and 9,211 individuals in Medicaid or Dr. Dynasaur plans.

After a new customer checks out a plan, they must make an initial premium payment and have their selection processed before they have an active health plan. Of the 15,422 individuals who checked out, 11,704 have completed the enrollment process and have an active health plan (i.e., effectuated enrollment). Of those who completed the process, 3,471 are on a Qualified Health Plan and 8,233 are on Medicaid or Dr. Dynasaur.

Renewing 2014 Vermont Health Connect Plans

I'm not at all surprised that the exchanges are starting to announce "tax season" enrollment periods already. The only thing I'm surprised by is the length of these special periods. I figured they'd do something like April 1st - 15th...instead, all 3 (Washington, Minnesota and now Vermont) are going for 2-month periods or even longer:

  • WA: 2/17 - 4/17 (effectively just extending the enrollment period by 2 months)
  • MN: 3/01 - 4/30
  • VT: 2/16 - 5/31 (a full 3 1/2 months...with the caveat that it has to be "within 60 days of discovering" that they have to pay the fee, which isn't exactly the sort of thing that one can prove one way or the other, y'know?)

Again, it's important to keep in mind that there are 3 main reasons for having a deadline/cut-off at all: First, prevents people from gaming the system by waiting until they're sick to enroll. Secondly, it allows the insurance companies ample time for their actuaries to crunch the numbers for the next year. Finally, it acts as a great motivator, as evidenced by the huge surges in December and again last week (even if the 2nd surge wasn't quite as large as I was expecting).

Three more updates to the #ACAOvertime Deadline Extension Roundup:

  • First, as noted this morning, California has tacked on an extra 2 days to their "In Line by Midnight" period (previously ending on 2/20; now extended to 2/22)

But by February 18, the exchange was offering an extension to people who tried to enroll by February 15 but were unable to do so by the deadline.  This has not been published on the exchange website, but an exchange representative confirmed that the extension runs through February 23, and that the call center (855-899-9600) will help enrollees complete the process between now and then.

D'oh! OK, one more late-breaking number today, out of Vermont:

Vermont Health Connect Open Enrollment and Renewal Update

The following numbers are up-to-date as of 11:59pm Monday, February 9, 2015.

New Vermont Health Connect Customers

12,344 individuals have checked out a 2015 health plan. This includes 4,786 individuals in Qualified Health Plans (private health insurance) and 7,558 individuals in Medicaid or Dr. Dynasaur plans.

After a new customer checks out a plan, they must make an initial premium payment and have their selection processed before they have an active health plan. Of the 12,344 individuals who checked out, 10,678 have completed the enrollment process and have an active health plan (i.e., effectuated enrollment).  Of those who completed the process, 3,293 are on a Qualified Health Plan and 7,385 are on Medicaid or Dr. Dynasaur.

Renewing 2014 Vermont Health Connect Plans

The latest numbers out of Vermont...

The following numbers are up-to-date as of 11:59pm Monday, January 26, 2015.

New Vermont Health Connect Customers

10,399 individuals have checked out a 2015 health plan. This includes 4,098 individuals in Qualified Health Plans (private health insurance) and 6,301 individuals in Medicaid or Dr. Dynasaur plans.

After a new customer checks out a plan, they must make an initial premium payment and have their selection processed before they have an active health plan. Of the 10,399 individuals who checked out, 8,853 have completed the enrollment process and have an active health plan (i.e., effectuated enrollment).  Of those who completed the process, 2,713 are on a Qualified Health Plan and 6,140 are on Medicaid or Dr. Dynasaur.

Renewing 2014 Vermont Health Connect Plans

Unless a customer requested otherwise, all individuals who had an active health plan through the end of 2014 currently have health insurance coverage through Blue Cross Blue Shield of Vermont, MVP Health Care, Medicaid or Dr. Dynasaur. The insurance issuers have their information in their systems and ID cards remain active.

A few days ago I posted an article about how Rhode Island is having trouble scraping together the $19 million or so that they need to operate HealthSource RI, now that the federal funds have pretty much dried up and the exchange has to pull its own weight. Some exchanges were set up with a funding mechanism in place (generally by charging either the insurance companies operating on the exchange, or the enrollees themselves, some sort of tax or fee), but others, like Rhode Island, were funded with federal dollars but never got around to setting up a way to pay for themselves after that funding stopped.

Anyway, a Republican state legislator in RI came up with an ingenious solution: Dump the exchange, even though it's functioning perfectly well. The reasoning is that the federal exchange, Healthcare.Gov, is operating more efficiently, so why not just do what Oregon and Nevada had to do this year (due to technical problems) and add themselves to the pile of 3 dozen states already being run through HC.gov?

The Vermont exchange just released their latest numbers:

New Vermont Health Connect Customers

9,454 individuals have checked out a 2015 health plan. This includes 3,791 individuals in Qualified Health Plans (private health insurance) and 5,663 individuals in Medicaid or Dr. Dynasaur plans.

After a new customer checks out a plan, they must make an initial premium payment and have their selection processed before they have an active health plan. Of the 9,454 individuals who checked out, 7,981 have completed the enrollment process and have an active health plan (i.e., effectuated enrollment).  Of those who completed the process, 2,506 are on a Qualified Health Plan and 5,475 are on Medicaid or Dr. Dynasaur.

Renewing 2014 Vermont Health Connect Plans

Unless a customer requested otherwise, all individuals who had an active health plan through the end of 2014 currently have health insurance coverage through Blue Cross Blue Shield of Vermont, MVP Health Care, Medicaid or Dr. Dynasaur. The insurance issuers have their information in their systems and ID cards remain active.

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