2018 MIDTERM ELECTION

Time: D H M S

West Virginia

Another fairly straightfoward state: Three carriers, two of which (CareFirst and Health Plan of Upper Ohio Valley) appear to be assuming CSR payments will be paid; the third, Highmark BCBS (which holds the vast bulk of the individual market) openly states that they assume they won't be made and that the mandate won't be enforced to boot. I'm once again assuming roughly 2/3 of Kaiser Family Foundation's "Silver CSR hike", which in this case would be about 10%, giving the following: 17.8% if CSR payments are made, 27.8% if they are:

Of the 31 states which have expanded Medicaid under the Affordable Care Act, only a handful issue regular monthly or weekly enrollment reports.

I noted in February that enrollment in the ACA's Medicaid expansion program had increased by around 35,000 people across just 4 states (LA, MI, MN & PA).

It's early June now, so I checked in once more, and the numbers have continued to grow. I have the direct links for 5 states now (including New Hampshire)...

Assuming 37,000 people enroll in private exchange policies by the end of January, I estimate around 25,500 of them would be forced off of their private policy upon an immediate-effect full ACA repeal, plus another 169,000 enrolled in the ACA Medicaid expansion program, for a total of over 195,000 West Virginians kicked to the curb.

As for the individual market, my standard methodology applies:

Last week I noted that with 41 states accounted for and the 2017 Open Enrollment Period quickly bearing down on everyone, it was time to pull the plug on my 2017 Average Rate Hike project and move on. I had come up with an overall national weighted unsubsidized average rate increase of around 25% for ACA-compliant individual market plans.

However, I also noted that I'd make sure to fill in the approved rates for the remaining 10 states as they came in, for completeness sake...and today, thanks to the HHS Dept. cutting the ribbon on 2017 Window Shopping at HealthCare.Gov, I've also been able to fill in the blanks for five of the remaining states all in one shot (the other five remain elusive).

There's been story after story over the past few months about insurance carriers large and small either dropping out of the ACA exchanges or (in the case of 4 co-ops) going belly-up altogether. Along the way, there have also been a few stories about other carriers expanding into new states or additional counties in states they're already participating in.

Case in point:

Residents in more West Virginia counties will have additional health plan options when the open enrollment period on the Mountain State’s insurance exchange, created in the Affordable Care Act, opens on Nov. 1.

In its 2nd year in West Virginia, CareSource, a nonprofit managed care provider based in Dayton, Ohio, is expanding its coverage area to include 32 counties.

...In 2016, CareSource is providing health insurance coverage to more than 1,300 West Virginia residents in ten counties: Brooke, Cabell, Hancock, Kanawha, Lincoln, Marshall, Mason, Ohio, Putnam, Wayne.

Lots of stuff happening fast & furious these days as #OE4 approaches. Instead of individual posts, I'm gonna cram 7 state updates into a single one...and am also cheating a bit by cribbing off of excellent work by Louise Norris over at healthinsurance.org (which is fair, since she also gets some of her data from me as well):

ALABAMA: Here's what my requested rate hike table looked like for Alabama on August 1st:

Updates: Norris Confirms that:

As I noted Monday morning, I believe that August 1st was the deadline for every state to submit their 2017 rate filings, meaning that the 14 states missing from my Requested Rate Hike Project are finally available to be plugged into the spreadsheet. I'll also be going back through the other states I've been tracking since as early as April to see which ones require updates due to carriers dropping out, joining in or resubmitting their rate requests.

With all of the lawsuits against the ACA flying around over the years, there are some which I haven't even heard about. One of them just came to my attention this morning (thanks to Nicholas Bagley for the heads' up): The State of West Virginia vs. the HHS Dept:

Elbert Lin, Solicitor General, Office of the Attorney General for the State of West Virginia, argued the cause for appellant. With him on the briefs were Patrick J. Morrisey, Attorney General, and Julie Marie Blake, Assistant Attorney General.

Lindsey Powell, Attorney, U.S. Department of Justice, argued the cause for appellee. With her on the brief were Benjamin C. Mizer, Principal Deputy Assistant Attorney General, and Alisa B. Klein and Mark B. Stern, Attorneys.

Before: KAVANAUGH and WILKINS, Circuit Judges, and SILBERMAN, Senior Circuit Judge.

Opinion for the Court filed by Senior Circuit Judge SILBERMAN.

Huh. This is an unexpected but welcome and very specific tweet from the West Virginia Dept. of Health & Human Resources:

173,582 West Virginians are enrolled in Medicaid expansion as of Monday, May 9, 2016.

— WV DHHR (@WV_DHHR) May 9, 2016

I haven't written much about West Virginia, and the last time I addressed their Medicaid expansion data was way back in September 2014, when they hit around 150,000 enrollees...or 100% of the total number thought to be eligible for the program.

Either those estimates were off, or the economic situation has changed over the past year or two. It's also conceivable that the state has deliberately nudged some "traditional" Medicaid enrollees over to "expansion" status in order to save money (remember, the federal government only pays 74% of the cost of "traditional" Medicaid, but 100% of expansion, though this gradually drops to 90% over the next few years).

West Virginia is pretty easy to calculate. Their total 2014 individual market was only 42,225 people (including "grandfathered" plans...WV did not allow "transitional" policies to be extended beyond 2013), and they had 33,421 people select exchange-based QHPs during the 2015 open enrollment period, of whom 31,106 were still effectuated as of 6/30/15.

Assuming about 5% are "grandfathered" (and not part of this risk pool), and assuming their total individual market grew by about 20% this year (this has been typical of many other states), that means they should have around 48,000 ACA-compliant enrollees at the moment (31K exchange-based plus another 17K or so off-exchange).

According to this article, WV's uninsured rate in 2013 stood at rougly 255K, of which 150K were eligible for the ACA's Medicaid expansion provision. Apparently they hit 145K as of 2 weeks ago...or 97% of the total eligible.

Now, the way the article words it, it's conceivable that the 145K figure could include some renewals and/or "woodworkers", which would mean that the actual percent of newly eligible WV residents is somewhat lower.

However, according to the Kaiser Family Foundation estimates, as of last fall WV actually had around 267K uninsured, of which only 143K were eligible for Medicaid expansion. Furthermore, as of mid-July, the number of Medicaid enrollees specifically designated as "due to ACA expansion" already stood at 132,556, which means that we're talking about some number between 132K - 145K...out of some other number between 143K - 150K.

In other words, West Virginia has now enrolled a minimum of 88% of those eligible for Medicaid expansion...up to a maximum of 101%!!

Wow! This editorial is fairly short but chock full of great up-to-date enrollment data: Exchange QHP enrollment has risen exactly 6,000 people since April 19 (an increase of over 30%); the Medicaid expansion tally is up by 4,556 to 132,556 people (almost 93% of the total eligible), and the overall uninsured rate has plunged from 17% to just 6.6%...all in less than 10 months. Amazing.

President Barack Obama’s Affordable Care Act is a superb success in West Virginia, according to new reports.

A total of 132,556 lower-income West Virginians have gained coverage through the Medicaid expansion approved by Gov. Earl Ray Tomblin. An additional 25,856 were able to enroll in subsidized private insurance plans. And about 18,000 young adults were allowed to remain covered by their parents’ policies until age 26.

That’s more than 176,000 Mountain State people who gained the ability to visit a doctor, get prescriptions filled or receive hospital care. Hurrah. It’s a big advance for compassion and humane values. Everyone should have access to medical treatment, and nobody should be left out.

The Kaiser Family Foundation estimated that WV has 143,000 residents eligible for Medicaid expansion. This means the state has now enrolled nearly 89% of them:

"The fast-track enrollments, on average, cost West Virginia about $6.50 less than would a full Medicaid application," the report states, estimating the staff worker received $14 dollars per hour.

Multiplying the 71,860 people who enrolled by that dollar amount provided a savings of roughly $470,000, according to the report. The state spent $200,000 in IT upgrades that also allowed it to mine the SNAP data base for potentially eligible residents. Subtracting those costs, the report argues the state saved about $270,000.

Bowling said the most up-to-date data show about 128,000 people have joined Medicaid through the expansion, much more than the roughly 91,000 anticipated to sign up. She said that success means the state probably won't send out another round of letters, but the numbers keep rising as those eligible may sign up at any time.

According to the Kaiser Family Foundation, about 143,000 residents are eligible for expanded Medicaid under the ACA, so this means that the state has already signed up over 86% of the total eligible since October:

Under the health care reform law, West Virginia expanded its Medicaid program to cover those who earn up to 138 percent of the federal poverty line, or about $16,000 a year for an individual. As of May 27, 123,403 West Virginia residents had signed up for Medicaid under the expanded program.

I actually already posted an entry using this exact same story out of the WV Gazette, but thanks to Esther Ferington for pointing out something else that I missed in the article:

Health insurance enrollment numbers through the federal exchange surged to 18,631 between March 31 and the April 15 federal extension, Highmark West Virginia President Fred Earley said.

Highmark, the only insurer participating in West Virginia's Affordable Care Act insurance marketplace, also reported that 6,171 people have enrolled directly through Highmark since Oct. 1. 

The numbers released represent the highest jump in enrollment the company has seen since the ACA rollout; it reported in April that, as of March 31, 14,839 people had enrolled through the exchange and 5,292 purchased plans directly through Highmark. 

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