"Rate Watch": Protect Our Care takes my Rate Hike Project ball and runs with it
For three years now, I've been painstakingly tracking the annual average rate increases for ACA-compliant individual market policies across all 50 states (+DC) and nationally, including both the on & off-exchange markets in as much detail as possible, and at the risk of tooting my own horn too much, my track record on this has been pretty damned accurate:
- In mid-October 2015, I projected that the overall average rate increases for 2016 would be roughly 12-13% nationally...which was confirmed by mid-December, when the Robert Wood Johnson Foundation released a report which, when you weighted the averages by metal level market share, came in at around 11.6% across the entire ACA exchange market. The off-exchange market wasn't included by RWJF, but unless it was significantly higher or lower, that 11.6% should be pretty darned close.
- In 2016, I concluded that the average unsubsidized rate hikes for 2017 would likely be about twice as high: Around 25% nationwide. When the official ASPE report came out sometime later, they concluded that the average Silver benchmark policy was going up around 22%...except that they only included 44 states, only included the on-exchange market, and again, only included the benchmark Silver plan, whereas I included all metal levels wherever possible (Bronze, Silver, Gold and Platinum).
- Finally, last fall, I concluded that average rate hikes for 2018 would likely be higher still: Around 29% nationally...and I further concluded that around 60% of this (~17% or so) was due specifically to several deliberate actions designed to sabotage the ACA markets. The first part of this (~29%) was confirmed first by the Urban Institute and then, officially, by the Centers for Medicare & Medicaid themselves: Not only was I within 1 percentage point of the actual average nationally, on a state-level basis I was within 5 percentage points in 24 states and within 10 points in a dozen more.
Note: When looking at the pie chart below, there are two important things to keep in mind:
- 3 small states didn't add any CSR load this year but will presumably be doing so next year (Vermont, North Dakota and DC).
- Some may be confused by seeing an "Individual Mandate" portion for 2018 when the mandate repeal doesn't actually go into effect until 2019, but no, this is not a case of "double-dipping": This portion of the estimate is based on the anticipation of the mandate not being enforced in 2018, which is not the same thing as the mandate actually being formally repealed. In addition, while most carriers specifically called out the CSR factor in their 2018 filings, only a small number were so clear about the potential for mandate nonenforcement, making that portion fuzzier. Finally, the "mandate" portion also includes a hodge-podge of other sabotage factors mentioned by some carriers (half-length enrollment period, slashed marketing/outreach budget, etc.)
For 2019, there's a couple of new/enhanced sabotage tactics being pushed by the Trump Administration, primarily the actual repeal of the individual mandate and the stripping of restrictions on short-term and association plans. The first few preliminary 2019 rate filings have already started to come out from Virginia, Maryland and Vermont, and I'm of course doing the same thing for a fourth year in a row:
- VIRGINIA: Average rate hike requested: 13.4%; would likely have averaged around a 5.7% drop without 2018 sabotage effect
- MARYLAND: Average rate hike requested: 29.5%; would likely have averaged around 19-24% without 2018 sabotage effect
- VERMONT: Average rate hike requested: 8.6%; would likely have averaged around 3.5% without 2017/2018 sabotage effect
Of course I'll be archiving all 50 states as the filings are released at this link.
Well, healthcare policy advocacy organization Protect Our Care has just launched their own, higher-tech version of my own Rate Hike Project with a new website called, simply enough, "Rate Watch":
While spending most of last year trying to repeal the Affordable Care Act and waging a war on our health care, President Trump and Republicans in Congress have also used their control of Washington to actively undermine the health insurance marketplaces every chance they get – leading insurance companies to raise premiums for 2018 and 2019 and, in some cases, forcing them out of the individual market altogether. At the same time, they gave insurance and pharmaceutical companies hundreds of billions of dollars in tax breaks.
Washington Republicans’ goal is simple: Sabotage and undermine the affordable care act, then blame everyone but themselves for the consequences of their actions.
They include a slick interactive map and so forth, and will presumably be including additional information/links that I might not do myself, but at the end of the day, this is really just a higher-profile, better-funded version of what I've been doing myself for three years now. (I'm not criticizing them for this--I'm thrilled that more people will be educated/informed about the causes behind the rate increases--but I admit to finding it a bit amusing).