Over the weekend I finally started plugging every state which have 2016 premium hike data for into a chart to see if any patterns were showing up, but I was still missing 6 states. I concluded that Medicaid expansion does not appear to be a major factor (or, at least, not an obvious one), but that there are two other clear trends:
First, states which are allowing "transitional" plans through next year are definitely seeing higher percentage rate hikes than those which stuck to their guns and discontinued non-ACA compliant policies.
Second, states which have only published requested rate changes are currently noticeably higher on average than those which have been put through the regulatory approval process.
Today I'm posting updated versions of all three charts, with some slight updates:
For most of the states I'm analyzing, I have hard enrollment numbers for the insurance carriers requesting rate hikes over 10%; it's the remaining companies (the ones seeking hikes of less than 10%) which are generally the big unknowns.
In Mississippi's case, this is flipped around: There appear to only be 4 companies offering individual policies in the entire state, and while I'm missing the enrollment number for the biggest one (BCBSMS), I can calculate a pretty close estimate due to a unique factor: Neither of the two asking for >10% hikes are offering exchange-based policies:
Assuming subsidies remain in place, none of the individual plans available in Mississippi’s exchange have requested double digit rate increases for 2016. The only exchange plan requesting a rate increase of ten percent or more is a small group plan from United HealthCare. Rate increases of at least ten percent are published on Healthcare.gov’s rate review tool, and the only individual market Mississippi plans on the list are off-exchange.
As with many other states, I'm working with limited enrollment and rate change data here, so plenty of caveats abound. However, Alabama's 2014 individual market was only around 206,000 people, and the ACA-compliant market should be roughly the same this year. I can account for 176,000 of that, so the remaining 30K or so are unknown other than being split among a half-dozen companies which requested rate changes of below 10% increases.
Assuming around 7% on average for the balance, Alabama residents are likely looking at roughly a 24.4% rate hike...assuming they stick with their current plans.
In other words: Shop around, shop around, shop around!
There's an old saying: Figures lie and liars figure. Statistics and percentages are a funny thing; as politicians of every stripe know, you can often twist them to mean whatever you like, especially when you don't provide proper (or sometimes any) context whatsoever. Case in point: Yesterday's embarrassingly dishonest "chart" presented by Representative Jason Chaffetz at the Planned Parenthood witchhunt committee hearing.
For a less inflamatory example of this, consider the headline of this entry:
Delaware: *Approved* 2016 rate hikes reduced by 11.4%!!
At first glance, of course, it looks like I'm saying that after going through the regulatory approval process, the individual health insurance premium rates in Delaware are being reduced by 11.4% next year! Hooray!
As part of a renewed attack on the Affordable Care Act, House Republicans grilled Access Health CEO James Wadleigh and the heads of other state health insurance marketplaces Tuesday, saying they had wasted billions of taxpayer dollars on an effort that has raised health insurance deductibles and premiums.
“In many states, physicians aren’t taking any new Medicaid patients. Focusing on uninsured rates is not the only parameter,” Rep. Greg Walden, R-Ore., said.
Last week I made a valiant effort to convert my 2016 individual market percentage rate ncrease project into actual dollar figures--that is, I tried to figure out how much premiums are likely to increase, on average, in each state, in actual dollars. After all, saying that a policy premium "went up 50%" while another "only" went up 5% for the same person doesn't tell you much if the first one started out at $200/month and the second one was already $300/month. Unfortunately, I failed at doing this; way too many variables and too much missing data.
However, I am able to provide a sneak peak at average rates on the New Mexico individual and small group markets next year, for individual enrollees at 5 different ages, in all 5 different coverage regions:
This issue brief reflects lessons learned from how consumers handled the new intersections between health coverage and the tax filing process in 2015. Drawing on public data as well as Enroll America’s private survey research and outreach efforts, this issue brief examines the policy framework underpinning the linkages between taxes and health coverage, messaging considerations and opportunities, and effective partnerships to maximize enrollment. Based on this analysis, the report concludes with recommendations for policymakers and other enrollment stakeholders about how to improve the consumer experience.
Rep. Jason Chaffetz (R-UT) stumbled near the start of a tense hearing on Tuesday when Planned Parenthood President Cecile Richards told him to check his sources on a chart that he said showed a decrease in breast exams and an increase in abortions by the organization.
Every month the CMS division of the HHS Dept. issues a formal Medicaid/CHIP enrollment report, and pretty much every month (until now) the numbers have grown rapidly. This has been the case even during the "off-season", since there isn't an off season for Medicaid/CHIP enrollment; those eligible for the programs can enroll year-round (on the other hand, promotion/outreach efforts are higher during Open Enrollment, so enrollment does still tend to be more rapid during that period).
South Dakota may join 30 other states in expanding its Medicaid program if federal officials approve a plan Gov. Dennis Daugaard is set to outline to the nation’s top health and human services administrator in Washington on Tuesday.
The Republican governor is meeting with Health and Human Services Secretary Sylvia Burwell to explain the plan, and the federal government has so far been more open to discussions than in the past, said Tony Venhuizen, chief of staff to Daugaard. The proposal, which is in its early stages, would make about 48,500 South Dakota residents newly eligible for the program.
The twist this time is that the Indian Health Service, which provides healthcare coverage for around 2 million Native Americans nationally, would be involved:
A few weeks ago, I crunched the (minimal) enrollment/rate numbers for South Dakota and came up with a fairly ugly weighted average rate hike of 27.4% (ouch). Being such a small state & population, there are only 5 insurance companies total offering individual policies either or off the exchange: Avera, Sanford, Welmark, Celtic and SD State Medical Holding, otherwise known as "DAKOTACARE" for some reason (and no, I refuse to capitalize the whole thing in the headline).
This evening Louise Norris informed me that DAKOTACARE has made 2 rather startling changes of plan: First, they're dropping off of the ACA exchange and will only be selling policies off-exchange...and instead of their previously-requested 18-20% rate hike, they've suddenly decided that they have to jack up rates an eyebrow-raising 63% next year.
As I've plugged new states into my 2016 Rate Increase estimate project, many people have asked me whether I'm seeing any patterns emerging in terms of which states are seeing higher average rate hikes vs. lower ones. The main question being asked is whether Medicaid expansion seems to have an impact (and by extension, is there any sort of red/blue political pattern emerging).
Until now, I've always answered either "no" or "too soon to tell", mainly because there were still lots of states missing or because so many of the estimates are based on requested increases rather than approved. As of today, however, I've managed to put together at least a ballpark estimate for 44 states (+DC), leaving just 6 states left, so I think I have enough included to look for patterns.
Remember: that six states (Alabama, Mississippi, Nebraska, Pennsylvania, Virginia and Wisconsin) are missing from all of the following graphs.
First, here's the weighted state-wide averages with the states in alphabetical order:
Rates for 2016 won’t be finalized until late summer or early fall, but of the three carriers that participated in the exchange in 2015, two – Blue Cross Blue Shield of North Dakota and Medica Health Plans – have requested double digit rate increases for 2016. BCBS of ND has proposed an average rate increase of 18.4 percent for their 29,000 individual market policy-holders (including on and off exchange plans) BCBS of ND has 70 percent of the on-exchange market share in 2015.
Medica has proposed an average rate increase of 16.5 percent, for an estimated 4,778 members, including on and off-exchange.
Sanford’s proposed rate increases were less than 10 percent, as they do not appear on Healthcare.gov’s rate review tool.
It's been awhile since I've crunched the numbers for a new state. As I noted a week ago, I've covered 42 states representing 87% of the total population, so any further changes assuming 100% of current enrollees stay with their current policy are likely to be fairly nominal unless various insurance regulators surprise me and slash the approved rate hikes significantly in a few states.
Thankfully, Louise Norris has picked up the ball and seems to be filling in some of the missing pieces using my own methodology, including North Dakota and South Carolina. I'll tackle the Palmetto State first:
Rates have not yet been approved for 2016, but Healthcare.gov’s rate review tool shows proposed rates from carriers that have requested rate increases of ten percent or more. In South Carolina, that applies to two current exchange carriers:
Among the various provisions of the Affordable Care Act, the one which intrigued me the most was the creation of 23 "Consumer Operated and Oriented Plans", or "CO-OPs". The idea was to create non-profit quasi-public/private healthcare insurance organizations (similar in nature, I believe, to Credit Unions, except for health insurance), to compete with the private, profit-based insurance providers.
Unfortunately, as the Office of the Inspector General noted in a July report (in huge font size for some reason), after two Open Enrollment periods have come and gone, the ACA CO-OPs aren't doing very well for the most part, to put it mildly.
Last night I posted what seemed, at first, to be a merely-amusing (if a bit depressing) story about a Florida news station website accidentally (?) reposting a year-old AP newswire story about potential security vulnerabilities at Healthcare.Gov:
(I was originally going for Albert Brooks' famous quitting scene from "Lost in America"...unfortunately the audio cuts out after the first 30 seconds...)
OK, this is kind of cool (though I didn't find out about it until 6 months later)...
The link to this site is below the video at the actual YouTube link, and The Graph only onscreen for a second (and is obviously a bit outdated...the effectuated exchange enrollee number is more like 9.9 million as of now), but it's still pretty nifty.
WASHINGTON -- The government's own watchdogs tried to hack into HealthCare.gov earlier this year and found what they termed a critical vulnerability - but also came away with respect for some of the health insurance site's security features.
Those are among the conclusions of a report released Tuesday by the Health and Human Services Department inspector general, who focuses on health care fraud.
The report amounts to a mixed review for the federal website that serves as the portal to taxpayer-subsidized health plans for millions of Americans. Open enrollment season starts Nov. 15.
So-called "white hat" or ethical hackers from the inspector general's office found a weakness, but when they attempted to exploit it like a malicious hacker would, they were blocked by the system's defenses.
I've been debating (pun intended!) how to handle the ongoing 2016 Presidential primary season when it comes to the ACA. While the ACA has barely come up at all in either of the first 2 GOP debates, it's almost certainly going to start popping up sooner or later (and I'll be stunned if it isn't a major topic at the Democratic debates).
I'm gonna try doing an occasional "Candidate Roundup" with the latest ACA-related happenings when it comes to the various candidates...and there have been three major developments this week:
In 2014, there was a tremendous amount of focus placed on whether or not "Obamacare Enrollments" (specifically referring to private ACA exchange enrollments) would or wouldn't hit the seemingly all-powerful target of 7 million people. Hell, the original (and still primary) focus of this website was specifically to do live tracking of private ACA exchange enrollments across all 50 states (+DC).
How did the "7 Million" figure become so all-powerful? As long-time readers (or anyone who remembers the past 2 years) will recall, "7 Million" took on an almost mystical quality. The media, along with detractors and supporters alike, began treating it as a make-or-break number; if the administration was able to hit the 7M mark, all would be well, and if they didn't, the earth would open up and swallow the entire nation whole.
Health Premiums Have Climbed $4,865 Since Obama Promised to Cut Them $2,500
Ouch. Sounds pretty bad, right? President Obama's "I'll cut premiums by $2,500 per family" promise has taken a lot of heat over the years, and rightly so. The figure originated in a back-of-the-envelope projection calculated by economist David Cutler, but referred to total healthcare costs:
We reached out to David Cutler, an economist who advised Obama during the 2008 campaign and helped calculate the $2,500 figure that appeared in Obama's speeches. He said the calculation encompassed total health care costs, not just premiums. These would include out-of-pocket costs, employer-provided insurance costs, and taxes to pay for public insurance programs.
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.
Secretary Burwell outlined the following key facts about Marketplace eligible uninsured:
About 10.5 million uninsured Americans are eligible for Marketplace coverage in the upcoming open enrollment.
While HHS will work to bolster enrollment across the nation, the Department’s top five target areas for outreach are Dallas, Houston, northern New Jersey, Chicago, and Miami – which are home to the highest numbers of uninsured who are eligible for Marketplace coverage.
Almost half of the uninsured individuals who are likely eligible for Marketplace plans are between the ages of 18 and 34.
Almost 40 percent of the uninsured who qualify for Marketplace plans are living between 139 and 250 percent of the federal poverty level (about $34,000 to $61,000 for a family of four).
Approximately one-third of the uninsured who qualify for Marketplace plans are people of color: approximately 19 percent are Hispanic, 14 percent are African American, and 2 percent are Asian American.
Secretary Burwell also described additional takeaways about the uninsured:
About half of the uninsured have less than $100 in savings.
Nearly three in five of the uninsured are either confused about how the tax credits work or don’t know that they are available.
At the time, I stated that as much of a supporter as I am of the ACA, I was a bit uneasy with this particular estimate, mainly due to the 2.3 million "Young Adults on Parents Plan" portion of it:
The first thing you'll notice right off the bat is that I'm treating the "additional" 2.3 million young adults in the second bullet point as a sort of afterthought.
This is not because I think that these people "don't count". Anyone who's been reading this site since I launched it a year and a half ago knows that I touted the "Sub26ers" as much as possible for the better part of a year.
Although nearly half of the country is covered by it, and the Affordable Care Act does impact it, I don't write much about Employer-Sponsored Insurance (ESI); there's a lot of facets to the ACA, and my main focus has obviously been primarily on the Individual Market (both on and off-exchange) as well as Medicaid (both expansion and "woodworkers").
Today, however, there are two big developments which relate directly to ESI:
When it comes to the Cadillac Tax, I know that it's supposed to help curb overall healthcare costs. I know that it's extremely unpopular with unions (which are obviously one of Clinton's core target constituencies). I know that it's supposed to be one of the main revenue sources for funding the rest of the ACA. Beyond that, I don't know much about it.
Economists love the idea of limiting the tax exclusion for employer-sponsored coverage. For one thing, subsidizing employer-based care is regressive — it's a tax subsidy paid, in effect, by people who don't have good jobs that give them health care. But perhaps more important, it encourages employers to spend more and more money on lavish health insurance, which in turn pushes up health-care costs across the system.
...But voters? They hate it. And employers really hate it. Coalitions have sprung up in Washington, DC, for the sole purpose of killing it. Hundreds of legislators on both sides of the aisle have backed a bill to repeal it. It's become one of Obamacare's central weaknesses — and thus one of the GOP's main targets.
That, however, is not the main point of this entry. This is:
Over at Forbes, virulently anti-ACA critics Josh Archambault and Jonathan Ingram have written a detailed analysis of What Went Wrong with Iowa's implementation of the Affordable Care Act's Medicaid expansion provision. While their tone is understandably hostile, from what I know of the situation, it seems to check out for the most part (granted, the only part of this piece I knew much about until now was the CoOportunity failure portion of it).
First, it's important to understand that Arkansas is not the only state which has been using a "private option" solution for their ACA Medicaid expansion program; Iowa opted for this as well. For some reason, Arkansas is the only state ever mentioned when this comes up, probably because they were the first ones to do so, I believe:
Iowa’s expansion was loosely modeled afterArkansas’ Obamacare expansion. Under Iowa’s “Marketplace Choice” waiver, able-bodied adults above the poverty line would receive Medicaid benefits through Obamacare exchange plans.
I've spent tons of time the past few months obsessing over the average percentageincrease in monthly premiums for ACA-compliant individual market policy enrollees, and as I wrap up this project, I've concluded that, assuming EVERYONE sticks with their current policies and doesn't bother shopping around, the overall national average increase will likely end up being between 11-15%.
However, aside from a few hypothetical examples, I haven't even touched on what this means in terms of the actual dollar amounts.
This is no small thing. "Percentage" changes can be very misleading, if you don't know what the actual dollar figure is in the first place. Consider this:
When patients need simple health care, they can get impatient about having to wait.
That’s prompted more health care systems to stress convenience.
This month, North Memorial Health Care will open two easy-access clinics in new Hy-Vee grocery stores in New Hope and Oakdale, hoping that shoppers might add treatment for warts, fever and other ailments to their grocery lists.
The resurgence of retail health clinics by hospital operators comes as they also pump money into online programs that let patients tap into care through computers and smartphones without leaving home.
This one is a heck of an eye-opener, considering the ongoing technical problems Vermont has had with their exchange website...
As always, once you're into the off-season, the total number of QHP selections is more of a symbolic milestone than anything, since the effectuated number is more significant...but it's the selections which cancel out attrition (whether voluntary, in the case of people not paying their premiums or moving on to other coverage; or involuntary, in the case of the several hundred thousand people kicked off of their policies due to legal residency verification issues).
I honestly thought that was the end of his story, but back in late August out of curiosity, I did check in on his GoFundMe page and found a link to a rather interesting, if belated correction over at the Charlotte Observer (the newspaper which posted his story in the first place):
For months now, regular readers know I've spent countless hours crunching the numbers in an attempt to figure out the national, weighted average rate increases for individual health insurance market premiums. I've dug into the numbers for just about every state, filling in hard data where I can and making educated guestimates where I couldn't.
For instance, If I found a state where I was able to get a hard weighted average of, say, a 15% increase for 50% of their market, but didn't know what increase the other 50% had been approved for other than it being "less than 10%", I've been assuming around 7% for the missing half, giving a total weighted average of (0.15 x 0.5) + (0.07 x 0.5) = 0.075 + 0.035 = 0.11 = 11.0%.
A couple of weeks ago, my post on Indiana's average 2016 rate increases on the individual market would likely be very close to flat, based on partial enrollment data (i.e., they provided the rate data for every insurance company, but enrollment data for only one of them). The one company they provided enrollment information for, Physicians Health Plan, also happens to have the highest average rate hike, 13.5%.
However, I noted that since a) Physicians only holds around 4% of Indiana's market, and b) several of the other companies were approved for rate decreases (up to -19% for Mdwise Marketplace), it's entirely possible that the state could be looking at an overall rate decrease, or a very low increase at worst. I decided to split the difference and go with a flat zero percent change until further notice.
A Twitter discussion with Andrew Sprung, along with my own prior grumbling about this issue, led me to actually compile the following list of just what "Medicaid" is actually called in each state.
Our discussion was specifically about some seemingly odd data he found in the U.S. Census Bureau's official healthcare coverage report released the other day; he was perplexed as to how come poor people seemed to increase their rate of private healthcare coverage while less-poor people increased their publicly-funded coverage, which seems rather backwards. In any event, one of the reasons noted by myself and "HotWxTakes" is that it's likely that a large number of those responding to the survey may have simply gotten confused as to whether their own coverage falls into the "private" or "public" category...most notably, confusion over "Medicaid". As I noted, "Medicaid" is operated at the state level, not federal, and is run under different names in different states, making some amount of confusion understandable.
As a progressive Democrat, I was thrilled when I heard Donald Trump was entering the Presidential race as a Republican, for obvious reasons.
I've been as guilty as anyone of treating Donald Trump like an entertainer, a joke.
For months, I've described Trump as being "Zaphod Beeblebrox with a mean streak". More recently I revised this to "Part Zaphod Beeblebrox, part Andrew Dice Clay".
I'm cheating a bit here; CT Mirror reporter extraordinaire Arielle Levin Becker has posted the key points from the AccessHealthCT monthly board meeting via Twitter:
Now, this is very interesting to me. Yes, the 2/22/15 QHP selection totally was around 110K, but compare 96,621 as of (I assume) mid-September against the HHS Dept's Q1 and Q2 reports:
In short, from what I can gather, the Affordable Care Act …
… the law which has consumed 99 percent of the Republican Party’s attention for the past 6 years or so …
… the law which has survived over 50 repeal attempts …
… the law which recovered from an unprecedented epic technical meltdown …
… the law which survived a federal government shutdown designed specifically to destroy it …
… the law which survived hundreds of millions of dollars worth of Koch Brothers attack ads …
… the law which survived two major Supreme Court decisions …
… proved to be worth perhaps three minutes of total airtime and discussion out of nearly four hours of Republican Party Presidential debate.
Because FOX News – FOX NEWS – had consciously decided that Obamacare is no longer a top issue to spend time screaming about.
Louise Norris has again done some of the heavy lifting for me over at healthinsurance.org, this time for New Hampshire:
In 2015, New Hampshire’s exchange had five carriers, up from just one in 2014. There will still be five carriers in 2016, although there’s one swap: Assurant/Time is exiting the market (nationwide), but Ambetter (offered by Celtic) is joining the exchange in New Hampshire.
...Two carriers in the exchange – Minuteman Health and Community Health Options – have requested double digit rate increases, although they have not yet been approved. Both carriers are CO-OPs created under the ACA, and both expanded into New Hampshire at the start of 2015, so their claims data for the state is very limited.
NOTE: The bold-faced clarifiers are important. For instance, unlike surveys by Gallup, the Kaiser Family Foundation and so forth, this report covers the full calendar year, which can make a big difference. It also cuts off as of the end of 2014, which means that none of the additional coverage added in 2015 is included.
Democrats in the Wisconsin Legislature are pushing a bill designed to prevent large increases in health insurance rates, but it’s doubtful Republicans who hold a majority and control the legislative agenda will get behind it.
The bill would require insurance companies give consumers 60 days’ notice for rate increases and require the state Office of the Commissioner of Insurance to hold public hearings on rate increases of more than 10 percent.
Over a year and half into Medicaid expansion and the launch of Kynect, the state’s health insurance exchange program, Kentucky is among the nation’s leaders in reducing its uninsured population.
As a result of providing more services to more people throughout the commonwealth, however, Kentucky hospitals are reporting healthy improvement in their revenues.
I want to get a couple of things straight right off the bat:
Yes, I wholeheartedly support single-payer healthcare...and in fact, the longer I track the ACA and the more I learn about the healthcare/health insurance system in America as a whole, the more certain I am that moving to single payer would make far more sense than the crazy-complex system we have today.
I agree with Bernie Sanders on most other issues as well, but I'm still leaning towards Hillary Clinton at the moment (and I'd be perfectly fine with Joe Biden if he were to jump in as well).
Even so, I still believe that the ACA is a massive improvement over the previous system, and I find it unlikely that single payer would be likely to happen at the national level for at least a decade or more even if Sanders were to win and the Democrats were to retake both the Senate (likely) and the House (extremely unlikely).
With all that out of the way, Tuesday's Wall Street Journal published an absolutely absurd story which tries to make it sound as though a) Bernie Sanders has proposed a specific, detailed Single Payer universal healthcare plan which b) would cost $15 trillion over the next decade c) on top of existing healthcare spending.
In my latest exclusive for healthinsurance.org, I take a deeper look at all 17 (er, 16) Republican Presidential candidates and how they might fare if "forced" to enroll via the ACA exchanges as Ted Cruz falsely claimed he had to earlier this year.
Way back in May, the requested rate hikes on the individual market for our nation's capital appeared to average roughly 5.3%. Earlier today, the District of Columbia Dept. of Insurance, Securities & Banking (DISB) announced the approved rate changes for DC:
DISB announced Sept. 15 the approved health insurance plan rates for the District of Columbia’s health insurance marketplace, DC Health Link, for plan year 2016.
Eight carriers through four major insurance companies – Aetna, CareFirst BlueCross BlueShield, Kaiser Permanente and UnitedHealthcare – will have plan offerings for individuals, families and small businesses on DC Health Link when enrollment opens Nov. 1, 2015.
As we head into the final batch of states, it looks like the national weighted average rate increases, which had been hovering in the 11-12% range up until a week or so ago, are unfortunately starting to inch upwards, slammed by 20%+ averages out of South Dakota, Montana, West Virginia, Oklahoma and Utah. Lower average rate hikes out of Connecticut and Wyoming have also been announced, but the other 5 states more than cancelled those two out.
And now you can add Tennessee to the mix. Starting with Louise Norris' exchange-only data (which comes in at a 33% average hike), I've also plugged in additional off-exchange individual market numbers to come up with what looks like an overall average rate hike of around 28.3%:
Wyoming's total individual health insurance market in 2014 was just 27,000 people. While the total market likely increased somewhat this year, those gains are likely offset by perhaps 15% being either "grandfathered" or "transitional" policies.
Just over 18,000 were enrolled in effectuated exchange-based policies as of June 30 of this year, leaving perhaps 9,000 more enrolled in off-exchange plans.
According to Louise Norris of HealthInsurance.org, there's only two companies operating on the exchange in Wyoming this year: WINhealth Partners and BCBS of WY. WINhealth is asking for a 13.37% average rate hike; Blue Cross is asking for an uknown increase...except that it's under 10%.
Over at HealthInsurance.org, Louise Norris has done her usual excellent job of summarizing the enrollment/rate/exchange participation situation for another state, Utah. As she notes, in addition to the companies which operated on the Utah ACA exchange this year, one more "mystery" company is expected to join in 2016. Of course, Louise only focuses on the companies actually operating on the exchange, while I'm looking at the entire ACA-compliant individual market state-wide (because the risk pool includes off-exchange policies as well).
Fortunately, Utah has a fairly comprehensive rate review database with an easy-to-use lookup feature. Unfortunately, a few of the entries don't quite jibe with HHS's RateReview website. Most notably, the HHS site claims that Arches Mutual Insurance has 2 filings from the same date: One requesting a jaw-dropping 58% hike, the other for a slightly less-insane 46.65% increase, neither of which includes the actual number of covered lives:
While their reports have always been comprehensive, they were also a bit confusing. Thankfully, starting with their June report, they've made the appropriate data points a bit more obvious. While the QHP selection total is still confusing, the effectuated number (which is really more relevant at this point) is the combination of APTC/CSR + non-APTC/CSR enrollees, or 74,583 + 59,617 = 134,200 people as of the end of June.
"Benchmark" in this case refers to the plans which are used as the basis for the ACA's Advance Premium Tax Credit (APTC) formula. How much/little these particular rates change is even more important than the change in other policy rates, because these are the ones which the federal tax credit amounts are based on.
This is really important, because if the benchmark policy rate in your area changes, it can seriously impact how you receive in tax credits...even if nothing has changed at your end.
Back in July, after several revised rate hike requests, the overall weighted average rate hikes requested for the individual market in Connecticut had dropped twice: From 7.7% overall to 7.2%, and then again to just 5.2%, as individual insurance carriers reevaluated their numbers and estimates.
Today, Arielle Levin Becker reports that the final approved rate changes have been released, and the overall, weighted average hike has dropped even further:
Premiums for the 55,000 people who buy Anthem Blue Cross and Blue Shield health plans through the state's individual market will rise by an average of 2.4 percent next year, while ConnectiCare Insurance Company's 34,400 customers will see an average rate hike of 8.5 percent.
Oklahoma is an example of how frustrating this rate review stuff can be, even when there's only a handful of companies involved and much of the data is easily accessible.
According to RateReview.Healthcare.Gov, Oklahoma only has a single company asking for rate hikes greater than 10%: Blue Cross Blue Shield of OK.
The main listing gives the requested rate increase as a jaw-dropping 43.95%...but the description below it says that "the range of rate increases by product is 22% to 34%".
Now, there are two additional BCBSOK listings on the Rate Review site which do appear to be included in the first one (all 3 list the total "members affected" as exactly 137,506)...but the other two have 22.64% and 33.83% listed as the "official" requested rate increase, both of which are still well below 44%.
How on earth you can have the individual product rate hikes range from 22-34% but average 43.95%, I have no idea. Obviously I'm missing something here.
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).
The Massachusetts Health Connector just held their monthly board meeting this morning, and have released the August dashboard report with a whole mess of demographic data for Baystate-obsessed nerds to revel in.
Effectuated QHPs have reached 175,605 enrollees...a whopping 35,065 higher (25%) than at the end of Open Enrollment.
While the national effectuation number is 2.3% lower or so today than it was in March (9.95 million vs. 10.19 million), in Massachusetts it's 42% higher. There's two main reasons for this, both connected to "ConnectorCare", which is unique to Massachusetts. ConnectorCare consists of the same low-end Qualified Health Plans that anyone can purchase (ie, they're still counted as QHPs in the national tally), except that in addition to the federal Advanced Premium Tax Credits (APTC), enrollees in ConnectorCare also receive additional state-based financial assistance, making them even more attractive to enrollees. In addition, however, unlike "normal" APTC or Full Price QHPs, which are limited to the official open enrollment period for most people, ConnectorCare enrollment, like Medicaid/CHIP, is open year round. That makes a dramatic difference, as you can see below; the vast bulk of the net QHP enrollment increase since March is thanks to ConnectorCare additions.
In addition, MA is the only state I know of which actively reports their attrition numbers--that is, so far this year they've had just 16,874 people drop their QHP policies, meaning a total of 192,479 people have selected a plan and paid at least their first monthly premium.
Assuming a 90% payment rate (confirmed for Massachusetts back in April), this also suggests that the cumulative QHP selection total should be roughly 213,000 people to date, which is only significant to me and The Graph.
But wait, there's more! Look below and you'll see a whole mess of pie charts, bar charts and line charts, breaking out everything from Metal Level selections and Market Share by Provider to SHOP enrollments (5,486 lives covered as of September 1st) and even Dental Plans!
PROVIDENCE, RI- HealthSource RI (HSRI), Rhode Island’s state-based health benefits exchange, reported today the percentage of Rhode Islanders lacking health insurance has been reduced by more than half since 2012, according to results of a robust, state-wide survey commissioned by HSRI. The Health Information Survey (HIS) showed a drop in the uninsured rate from 11 percent in 2012 to five percent in 2015 (margin of error of +/- one percent.) The comprehensive HIS survey of 5,000 households and more than 12,000 individual Rhode Islanders shows similar trends to other national surveys released in recent weeks.
As of 2014, key provisions of the Patient Protection and Affordable Care Act (PPACA) resulted in the establishment of health insurance exchanges in each state and changed how insurers determined health insurance premiums. Individual market consumers generally had access to more health plans in 2015 compared to 2014, and in both years the lowest-cost plans were available through exchanges in most of the 1,886 counties GAO analyzed in the 28 states for which it had sufficiently reliable data for plans offered either on or off an exchange. In addition, consumers in most of the counties analyzed had six or more plans to choose from in three of the four health plan metal tiers (bronze, silver, and gold) in both 2014 and 2015, and the percentage of counties with six or more plans in those metal tiers increased from 2014 to 2015. Consumers had fewer options regarding platinum plans, although the availability of platinum plans generally also increased from 2014 to 2015. The lowest-cost plan available in a county was available on an exchange in most counties. For example, among the 1,886 counties analyzed, GAO found that the lowest-cost silver plan for a 30-year-old was available on an exchange in 63 percent of these counties in 2014 and in 81 percent of these counties in 2015—an increase of 18 percentage points.
Yesterday I noted that the "sequel" (in spirit, not in actuality) to the King v. Burwell federal case, House v. Burwell, has been given the green light to proceed by a federal judge...or at least the part of the lawsuit most relevant to this site and most everyday people:
A federal judge ruled on Wednesday that House Speaker John Boehner's lawsuit over the implementation of Obamacare can move forward, setting the stage for another high-stakes legal battle over President Obama's signature legislative accomplishment.
The suit, brought by Speaker of the House John Boehner and the House Republicans, has two major components: Attacking the Obama administration for delaying implementation of the Employer Mandate portion of the ACA by a year (which was done because most businesses needed more time to prepare for this provision, and which is doubly stupid because the GOP has voted to repeal the entire law dozens of times anyway); and attacking the administration for implementing the Cost Sharing Reduction provision, which they claim the administration wasn't specifically authorized to do.
I posted about this back on July 3rd, just a week after the historic King v. Burwell Supreme Court ruling, which put the Constitutional seal of approval on the ACA's Advance Premium Tax Credits (otherwise known as the Federal Tax Subsidies) for over 6 million people across the 3 dozen Healthcare.Gov states.
The short version is that there's Yet Another lawsuit winding its way through the federal court system: House vs. Burwell. This is the one which is being brought by John Boehner and the House Republicans against the Obama administration. Here's the recap.
As I understand it, there's 3 main issues at hand:
9 of the 20 states which saw an increase in effectuated enrollees from 3/31 to 6/30 are state-based exchanges (remember, there's only 14 of these).
26 of the 30 states (+DC) which saw a decrease in enrollees are Healthcare.Gov states (mainly due to the 306,000 enrollees terminated due to legal residency issues).
The highest off-season increase: Massachusetts, which saw a 20.7% increase in enrollees mainly due to their policy allowing year-round enrollment in "ConnectorCare" QHP policies.
The worst off-season decrease: Mississippi, which lost 9.3% of their effectuated enrollees during the quarter.
Colorado's June number is listed as being identical to their March number because CMS was unable to verify their June enrollment and simply copied the March number over. Their unofficialJune 30 figure is 134,200, or about 9.1% higher than it was on 3/31.
The percent of enrollees with APTC (Advanced Premium Tax Credits) has dropped slightly, from 85% in March to 83.7% in June.
The percent of enrollees with CSR (Cost Saving Reduction) has also dropped a bit, from 57.4% to 56%
Both of these suggest that the bulk of those who have been kicked off for proof-of-legal-residency issues tend to be lower-income, which makes sense. Update: Andrew Sprung notes that some people may have lost their tax credits or CSR assistance without losing their policies if they reported an income change or if their original income claims can't be verified, so perhaps not).
The average federal tax credit amount has also gone down very slightly ($272/month to $270).
The Metal Level ratio, however, hasn't shifted at all; it remains 1% Catastrophic, 21% Bronze, 68% Silver, 7% Gold and 3% Platinum.
For months now, I've been operating on the assumption that the total number of currently effectuated private ACA exchange policies has been roughly 10.3 - 10.4 million, give or take. This was based on a combination of last year's enrollment pattern, the 214,000 additional people who selected QHPs during the #ACATaxTime special enrollment period, as well as assorted state-level enrollment updates out of California, Maryland and a few other state-based marketplaces.
Last year, GOP Governor Tom Corbett pushed through a poorly-conceived, overly-cumbersome "Republican alternative" Medicaid expansion program called Healthy PA, which didn't go into effect until late in the year. He was defeated by Democrat Tom Wolf, who vowed to scrap the "alternative" version and simply expand Medicaid to residents below 138% of the Federal Poverty Level, as the ACA had intended.
Department of Human Services Sec. Ted Dallas Tuesday announced the end of the transition from Healthy PA to traditional Medicaid expansion—known as HealthChoices in Pennsylvania—as the last of the expansion insurance plans took effect.
According to Sec. Dallas, 440,000 Pennsylvanians are enrolled in Medicaid expansion insurance plans with the last group of enrollees coming out of Healthy PA’s primary coverage options into Medicaid expansion.
“With that last group of folks moving over, the Medicaid expansion is now complete,” Sec. Dallas told reporters.
The obligatory update. Assuming around 8,000 off-season QHP selections per day nationally (which was recently confirmed by CMS...even higher than the 7,500/day I had previously been estimating), the grand total should be crossing the 13.5 million mark sometime this holiday weekend if it hasn't already.
This won't likely have any impact on the currently effectuated number of course, which is likely still hovering around the 10.4 million mark, but it's still an important symbolic milestone to achieve.
Montana's Dept. of Insurance website doesn't really provide the actual rate filings (or if it does, I can't find them), but it does include this handy chart laying out every carrier offering individual policies in the state (there's only four of them, and one, Assurant, just went belly-up this past spring). That leaves just three companies to track: BCBS of Montana, Montana Health COOP and PacificSource.
Fortunately (well, unfortunately, actually), all 3 of these are listed on Healthcare.Gov's "Rate Review" website, making it fairly easy to generate the weighted average. Sadly, it's grim news in Big Sky country next year:
According to their report, "100%" of South Dakota's individual insurance market products have requested double-digit rate hikes next year, which sounds bad.
However, also according to their report, "0%" of those products are seeking hikes higher than 20%.
According to Agile Health Insurance, in other words, every single South Dakota insurance plan sold on Healthcare.Gov is seeking somewhere between 10-20% hikes, right?
OK...but look what happens when you include the off-exchange "products" as well:
Basically, they looked at the total number of products (ie, collections of plans from the same insurer) in each state and broke them down by how many were seeking rate hikes of <10%, 10-20%, 20-30% and >30%, then divided those policies into the total number offered in the state.
Agile's report concludes that
Overall, 31 percent of Obamacare individual marketplace products had a double-digit rate hike proposed for 2016. Fourteen percent of Obamacare products on the federal exchange had a proposed rate hike of at least 20 percent, while 7 percent of products had a proposed rate hike of at least 30 percent.
It's important to read Mangan's opening sentence carefully, however:
Maryland was one of the first states to release their list of requested 2016 rate hikes, and caused quite a stir at the time due to the largest player in the state, CareFirst, asking for a whopping 30% rate hike. At the time, I didn't have much to go on in terms of hard enrollment numbers, but it looked like the weighted average request would be somewhat lower, perhaps around 22-23%.
Today, the Maryland Dept. of Insurance has released the final, approved rate changes, and while 5 of the 8 companies on the individual exchange saw reductions in their rate change (2 others were approved as is, and one, Kaiser Health Plan was actually increased from 4.8% to 10%), it's still difficult to lock down a fully weighted average due to some crucial enrollment data missing.
I was able to track down the "covered lives" data for 5 of the eight companies.
CMS awards $67 million in Affordable Care Act funding to help consumers sign-up for affordable Health Insurance Marketplace coverage in 2016
With Marketplace Open Enrollment set to begin on November 1, 2015, the Centers for Medicare & Medicaid Services (CMS) today announced grant awards totaling $67 million to support outreach efforts designed to connect people with local help as they seek to understand the coverage options and financial assistance available at HealthCare.gov.Awarded to 100 organizations located in 34 states that operate Federally Facilitated Marketplaces, State Partnership Marketplaces, and supported State-Based Marketplaces, the three year-long Marketplace Navigator grants will fuel efforts to help consumers enroll in a health plan that fits their budget and best meets their family’s needs.
Twenty-seven Alaskans were approved for benefits under Medicaid expansion Tuesday, the first day of the broadened health care program, the state Department of Health and Social Services announced Wednesday.
According to state officials, about 40,000 people are potentially eligible for the expansion program, although as Xpostfactoid pointed out a month or so ago, the Kaiser Family Foundation has a much lower estimate (more like 11,000).
Either way, the actual number enrolled or in the process is quite a bit higher than just 27...
A top official at the U.S. Chamber of Commerce said Thursday that the fight against Obamacare is largely over and that critics' energies were better spent fixing specific problems caused by the landmark healthcare legislation.
"There is a growing realization that repeal won't happen," Randy Johnson, the chamber's senior vice president of labor, immigration and employee benefits, told reporters during a Thursday press conference. "Some of the Republican proposals [relating to Obamacare] reflect this."
The nation's biggest business lobby was a staunch opponent of the legislation that created the Affordable Care Act in 2010. Johnson said the Chamber hadn't changed its opinion of the bill but did not see a viable path toward repeal. Instead, he said the most fruitful path involved legislation offering "targeted" changes to specific parts of the law.
"There is no unscrambling the omelette," Johnson said.
Native Americans can get an exemption from the requirement that everybody have health insurance. Under the health law, however, many Native Americans can get coverage under Medicaid, which serves low-income Americans, or buy subsidized plans through insurance exchanges. That allows them to receive treatment from private doctors and hospitals rather than rely solely on government and tribal facilities.
And the coverage allows Indian health facilities, which tribal leaders say are chronically underfunded, to bill insurers for care they already provide. And that additional revenue means doctors and hospitals can also offer new services.
Advocates also see the health law as a chance to reduce the health disparities that have long afflicted Native Americans, including rates of diabetes that are three times higher than the U.S. population and a life span that is four years shorter.
CMS awards $67 million in Affordable Care Act funding to help consumers sign-up for affordable Health Insurance Marketplace coverage in 2016
With Marketplace Open Enrollment set to begin on November 1, 2015, the Centers for Medicare & Medicaid Services (CMS) today announced grant awards totaling $67 million to support outreach efforts designed to connect people with local help as they seek to understand the coverage options and financial assistance available at HealthCare.gov. Awarded to 100 organizations located in 34 states that operate Federally Facilitated Marketplaces, State Partnership Marketplaces, and supported State-Based Marketplaces, the three year-long Marketplace Navigator grants will fuel efforts to help consumers enroll in a health plan that fits their budget and best meets their family’s needs.
This money is for the Navigator organizations, which effectively act as non-commissioned insurance brokers to help people enroll for healthcare policies via Healthcare.Gov.
FOR IMMEDIATE RELEASE
September 3, 2015
Contact: HHS Press Office
202-690-6343
HHS takes next step in advancing health equity through the Affordable Care Act
Proposed rule implements new protections against sex discrimination; enhances language assistance; protects individuals with disabilities; and extends to insurers participating in Health Insurance Marketplaces
Washington, DC-- Today, the Department of Health and Human Services (HHS) issued a proposed rule to advance health equity and reduce disparities in health care. The proposed rule, Nondiscrimination in Health Programs and Activities, will assist some of the populations that have been most vulnerable to discrimination and will help provide those populations equal access to health care and health coverage.
Delaware's 2016 rate hike analysis is about as simple and straightforward as it gets: Two companies (Aetna and Highmark BCBS) for both the individual and small group market, both on- and off-exchange, period...and their website includes the actual affected enrollee tallies for each, giving weighted totals:
Ugh. Nearly 25% requested for the individual market, just under 10% for the small group market. Of course these are requests only, so they might be slashed somewhat by regulators yet.
Louisiana's Insurance Dept. website is refreshingly complete: It includes every company on the individual & small group market, lists both the requested and approved rate hikes, and includes direct links to the filings which list the actual total enrollment in a clear-cut, consistent fashion.
In fact, the only data missing is some of the approved rate hikes; they've only posted the approved numbers for 3 of the 5 small group listings and 1 of the 10 individual listings, making it impossible to plug in the approved weighted average. However, the requested average is complete: About 15.4% for the individual market and 9.4% for the small group market.
While the Republican nominee for governor says he would dismantle the state health-insurance exchange branded as Kynect, a GOP senator is talking about not only keeping it, but expanding it to other states to pay for the other big feature of federal health reform: expanded Medicaid.
Sen. Ralph Alvarado of Winchester made the suggestion at a legislative committee meeting where Kynect Director Carrie Banahan said it would be "disastrous" to move Kentuckians to the federal Obamacare exchange, as Republican gubernatorial nominee Matt Bevin has said he will do if elected.
Alvarado, a physician, said his concerns about Obamacare in Kentucky are mostly monetary because the state will have to start paying 5 percent of the Medicaid expansion costs in 2017, rising to the reform law's limit of 10 percent in 2020.
...Alvarado suggested that Kynect become a regional exchange and charge other states for its services, using the profit to pay for the expansion.
Last year, while most state-wide average premium rates increased somewhat (averaging around 5.5% overall nationally, give or take), there were a few states which actually saw rate decreases from the year before: Arkansas, Mississippi and New Mexico saw overall decreases on their individual markets, while the District of Columbia and Hawaii saw decreases on their Small Business markets.
Beginning today, low-income uninsured Alaskans can apply for health coverage because of Governor Bill Walker’s decision to expand Medicaid as part of health reform. This makes Alaska the 29th state (plus the District of Columbia) to implement the expansion (see map).
Across the country, Medicaid expansion has produced state budget savings, and the historic gains in health coverage since health reform took effect have been greatest in expansion states. Now Alaska is poised to reap immediate and positive benefits of expansion: the state projects expansion will make 40,000 people eligible for coverage and could save the state budget up to $6 million this fiscal year, with greater savings in future years.
A couple of weeks ago, right after I left for vacation, both Marco Rubio and Scott Walker finally released "replacement plans" for the ACA. Rubio's was really just an op-ed sort of thing, but Walker's has received quite a bit of attention because it reminds people that he's still running for President and it actually bears some resemblance to an actual policy paper, which is more than anything else the GOP has come up with over the past 6 years.
I was planning on writing up my own analysis of each when I got back, but frankly, I'm too backlogged with other stuff (both ACA and day-job related...I need another vacation from my vacation now...). Plus, many, many others more knowledgable about these things than I have done fantastic writeups already:
