END OF 2018 OPEN ENROLLMENT PERIOD (42 states)

Time: D H M S

Virginia

In light of today's confirmation that the average 2016 premium rate increase ended up only being appx. 8% nationally on the individual market (as opposed to the headlines screaming about 40%, 50%, 60%+ rate hikes being "typical"), I've decided to get a jump on the 2017 rate changes. Someone gave me a heads up that Virginia appears to be first out of the gate this year, with requested 2017 rate filings having already been submitted by at least 8 carriers.

Now, for 2016 there are actually 13 carriers offering individual policies in Virginia (although some of these are available off-exchange only). I'm don't know if the 5 missing carriers have decided to drop out of the VA market or if they simply haven't submitted their 2017 filings yet (it looks like in Virginia the carriers technically have until July 15th to get their requests to the HHS Dept. in states which have their own rate review process, but the state itself presumably has an earlier deadline). It's also possible that some additional carriers might join the exchange and/or start offering policies in the state which don't this year.

In any event, here's what I've found so far for Virginia:

Some relatively welcome news going into the home stretch: After a series of ugly (over 20%) rate hike averages from Alabama, Delaware, South Dakota and especially Minnesota, I've just completed the Virginia analysis:

Unlike many other states, there's no guesswork or educated guesses here; the Virginia Dept. of Insurance SERFF filings are quite complete and straightforward, so I have every company providing individual and/or sm. group coverage listed, both on and off the exchange, with the exact average rate changes and affected enrollee numbers for pratically every one of them.

The only exceptions are Piedmont Community Healthcare HMO, whose SERFF filings, oddly, included the enrollee count but not the rate change (usually it's the other way around). In addition, there's a couple of new additions to each (UHC of Mid-Atlantic on the indy market, Federated Mutual on the sm. group market). However, none of these have large enough enrollment numbers to amount to more than a rounding error in either category.

Throughout the long, tortured life of the Affordable Care Act over the past 5+ years, one of the easiest attack points has been to go after the sheer bulk and complexity of the law itself. Whether you're referring to the actual wording of the law (supposedly a whopping 2,700 pages long) or, even worse, the 8-foot tall stack of 10,000 - 20,000 pages of regulations related to "Obamacare", Republican politicians, pundits and talk show hosts have used the immense size of the ACA itself to go after it.

I'm bringing this up now because my big project the past week or two has been to track down the various 2016 policy premium rate change requests for the companies operating both on and off the ACA exchanges in all 50 states (+DC, of course).

So far I've done a pretty good job with OR, WA, CT, MI, DC and VT...and I have partial data for MD & IA.

COLORADO: Exchange COO joins exodus, new system late

Colorado’s 2.0 “Kentucky-style” system that is supposed to simplify the way people get health insurance won’t be ready until days before the Nov. 15 open enrollment starts.

And as Colorado’s health exchange enters its busy season, a third “chief” has announced she’s leaving Connect for Health Colorado. Chief Executive Patty Fontneau departed in August. Chief Financial Officer Cammie Blais left two weeks ago. And Chief Operating Officer Lindy Hinman announced her resignation and plans to leave next month after open enrollment begins.

VIRGINIA: Funds to help Va. health care coverage signups

Virginia is getting $9.3 million in federal funding to help residents sign up for health insurance.

Gov. Terry McAuliffe said the money will help hire more than 100 people to help with enrollment that runs from Nov. 15 through Feb. 15.

Oy gevalt. I made a big stink about this bizarro story when it broke back in June, so it behooves me to post a follow-up now when it appears that at least one Democrat in Virginia (well, besides the "Democrat" who was the subject of the original bribe offer) was basically guilty of the same thing that the state Republicans were:

RICHMOND — Virginia Gov. Terry McAuliffe’s top lieutenant apologized Friday after admitting that he had tried to keep a Democrat from quitting the evenly divided state Senate with the prospect of a lucrative state job for the senator’s daughter.

But it was not entirely clear to Richmond’s increasingly bewildered and antsy political class just what Chief of Staff Paul Reagan had done.

Last week I noted that the "OMG!! GAZILLIONS OF POLICIES CANCELLED!!!" freakout over non-ACA compliant healthcare policies being sunsetted to be replaced by policies which are compliant with the law is about to raise its ugly head again this fall. Sure enough, we're off and running in Virginia:

After a year’s reprieve, up to 250,000 Virginians will receive notice by the end of November that their health insurance plans will be canceled because the plans do not comply with the Affordable Care Act and accompanying state law.

The affected policyholders were allowed to renew their old plans late last year, even though the plans did not provide all of the benefits required under the health care law, but they won’t have that option when the policies expire this year.

I went with 240K instead of 250K because later in the article it says:

Between my son being sick for the past 4 days (he's better now, thanks!), losing my internet connection for 2 days (it's back up now, thanks!) and just generally being swamped with work, I don't have time to give these stories the attention they deserve, but they're all worth checking out:

McAuliffe unveils 10-step plan to expand health coverage for Virginians

Beyond that [the 25,000 people being added to Medicaid], the strategy seeks to chip away at the ranks of the uninsured, by enrolling them in programs they already qualify but haven't signed up for. The state will launch a website to help Virginians enroll in health care coverage through existing programs such as Medicaid and will step up efforts to sign up more Virginians for the federal health insurance exchange, HealthCare.gov.

Bill Straub: Kentucky GOP’s rendition of ‘I’m Against It’ may hit sour note on health care

The Republicans controlling the Virginia state legislature have been fighting tooth & nail to prevent 400,000 of their fellow Virginians from receiving healthcare, but Democratic Governor Terry McAuliffe has finally found a way to squeeze 25,000 people onto Medicaid anyway by reshuffling the deck of existing executive regulatory rules:

RICHMOND — Gov. Terry McAuliffe (D) on Monday unveiled a plan to insure an additional 25,000 Virginians, a measure that falls far short of his vow to defy the Republican-controlled legislature and find a way to expand coverage to 400,000.

After losing a months-long Medicaid fight in June, McAuliffe declared that he would close the “coverage gap” on his own.

On Monday, he announced a much more modest series of proposals, primarily designed to improve care for people already in Medicaid and boost outreach efforts to people who already qualify for it, but are not enrolled.

The plan would change enrollment criteria for about 25,000 people, including 20,000 who are severely mentally ill and 5,000 children of state employees.

Three stories which didn't seem worthy of their own full blog entry but each of which are pretty interesting...

Washington State, 06/25/14: Kreidler calls for health insurers to end discrimination based on gender identity

OLYMPIA, Wash. – Insurance Commissioner Mike Kreidler is asking all health insurers doing business in Washington state to end discrimination in health insurance based on gender identity and related medical conditions.

In a letter sent to health insurers this morning, Kreidler reminded health insurers that exclusions and denials of coverage on the basis of gender identity are against the Washington Law Against Discrimination (RCW 49.60) and the federal Affordable Care Act (Section 1557).

...“Transgender people are entitled to the same access to health care as everyone else,” said Insurance Commissioner Mike Kreidler. “Whether specific services are considered medically necessary should be up to the provider to decide on behalf of their patient.”

Good.

Good for him. Not only is this the right thing to do, assuming it goes through (it sounds like the logistics will be a bit awkward to implement under the circumstances), it also makes the Virginia Republican Party look like even bigger jackasses than they already did (and don't even get me started on the former Democratic state Senator who agreed to their bribery scheme).

Virginia Gov. Terry McAuliffe (D) said on Friday that he planned to act administratively to expand health coverage in his state, defying the Republican-controlled legislature that maneuvered to block him from expanding Medicaid under Obamacare.

The specifics of McAuliffe's plan aren't clear. But he vetoed an item in the Virginia budget Friday that would have required the legislature to approve any expansion and asserted that he planned to "move administratively" to expand coverage to as many as 400,000 low-income Virginians.

A bunch of people have sent me links to this story out of Virginia:

RICHMOND — Republicans appear to have outmaneuvered Gov. Terry McAuliffe in a state budget standoff by persuading a Democratic senator to resign his seat, at least temporarily giving the GOP control of the chamber and possibly dooming the governor’s push to expand Medicaid under the Affordable Care Act.

Sen. Phillip P. Puckett (D-Russell) will announce his resignation Monday, effective immediately, paving the way to appoint his daughter to a judgeship and Puckett to the job of deputy director of the state tobacco commission, three people familiar with the plan said Sunday. They spoke on the condition of anonymity because they were not authorized to discuss the matter.

The short version is this:

Back when I assumed that I'd be pulling the plug on this website after March 31st, I didn't see the point of keeping track of the states which finally came around and added Medicaid expansion after the end of the Open Enrollment period. Not that I didn't think it was important, mind you; I just assumed that this site would be winding down in early April anyway, so it would be kind of pointless.

However, now that practically every state is extending their enrollment out to April 15 (or beyond, in a couple of cases) for those who started their application before Monday, along with the fact that Medicaid enrollment doesn't have a deadline anyway along with numerous other exceptions, it behooves me to make note of additions to the Expansion party as they come along.

OK, as noted a little earlier, I underestimated the February HHS Report for Exchange-based Private QHP enrollment by about 4.2%:

  • My Projection: 902,800 (4.202 million total)
  • Actual Enrollments: 942,833 (4.242 million total)

I'm perfectly happy to have underestimated. As for where the extra 40,000 enrollments came from, my initial guess would be that California, in particular, started ramping up their big March blitz a bit earlier and more successfully than I figured, which, again, I'm absolutely fine with. Update: Nope, actually, California's numbers plummetted in the 2nd half of Feb due to that ugly technical outage; see below for details.

I'm busily plugging the new enrollment numbers into the spreadsheet even as I type this, and will be updating with various notes and observations, so keep checking in.

OK, I've entered the QHP data; a couple of things to note:

UPDATE: On the down side, I was off by 4% this time around.

On the up side, I UNDERESTIMATED:

Actual Feb. enrollments: 942,833, for a total of 4,242,325 thru 3/01/14.

Sarah Kliff at Vox just announced that the February HHS report is expected to be released today at around 4:00pm. A few items in anticipation of that:

  • As I've noted several times, I'm projecting the report to total around 902,000 exchange-based private QHP enrollments for the month of February (technically 2/02 - 3/01)
  • If accurate, this would bring the cumulative total of exchange-based private QHP enrollments to 4.202 million (from 10/1/13 - 3/01/14)
  • From the data I have, the average daily enrollment rate in February was almost identical to that of January, which had about 1.146 million QHP enrollments. HOWEVER, the January report included five weeks of data (12/28 - 2/01), while the February report will only include four weeks (2/02 - 3/01). Therefore, even at the same daily average, it'll be about 20% lower no matter what.
  • Don't be surprised if Peter Lee of CoveredCA decides to steal some thunder by announcing that California has enrolled 1,000,000 QHPs all by itself either today or tomorrow. However, that would include the past 10 days, while the HHS number will only run thru 3/01.
  • If you want to get REALLY specific, call it 902,800 and 4,202,292.
  • I've been dead-on target 6 times in a row without hyping up my projections beforehand. This time I am hyping myself up beforehand, so I'll probably be way off...but as long as I've UNDERestimated the tally, I'll be perfectly fine with that...
  • The report will be released in about 5 minutes, but my kid gets home from school in about 10, so it'll be a good 20 minutes before I can really post anything. Feel free to follow Sarah Kliff of Vox in the meantime!

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