So far, only 4 states have released their preliminary 2020 ACA-compliant individual market premium rate filings: Maryland, Virginia, Vermont and Oregon.
However, it's a bit overly cumbersome: It stretches out over 5 full pages, and includes columns for Standalone Dental Plans as well as a bunch of info regarding the Small Group Market. I used to try tracking Small Group rates as well, but that got to be too difficult to keep up with, and I haven't really done much analysis of standalone dental plans at all. Let's face it: About 90% of the drama, controversy and confusion regarding ACA premiums is all about the individual market.
As many of you know, I've been operating ACASignups.net since October 2013. At first the project was intended purely as a volunteer part-time hobby. The site quickly consumed virtually all of my time and energy, and that has never stopped in the 5 1/2 years since.
My official job as a freelance website developer began to suffer, and several years ago I pretty much gave up website development in order to devote full time to my work analyzing/blogging about healthcare policy in general while also educating people and advocating for progressive healthcare policy reform.
reinstating the ACA's individual mandate penalty (similar to what Massachusetts, New Jersey and DC have done and what California is in the process of doing)
implementing a state-level reinsurance program (as over a half-dozen states, including several GOP-controlled ones, have done)
Democratic lawmakers introduced a dozen bills late last week to create the infrastructure, funding, and regulatory structure for a state-based system that would enable New Jersey officials to create, market, and sell health insurance policies to low-income individuals and small businesses with fewer than 50 employees.
It turns out that this was only part of a marathon voting session yesterdayover the past few weeks. Either the state Senate, Assembly or both have also voted to pass threea bunch ofother healthcare-related bills (I've included simple descriptions of each):
BREAKING: California Assembly passes our #AB1246(@Limon) to align consumer protections for all Californians, including those in large group coverage. #Care4AllCA
Federal law generally bars illegal immigrants from being covered by Medicaid. But a little-known part of the state-federal health insurance program for the poor has long paid about $2 billion a year for emergency treatment for a group of patients who, according to hospitals, mostly comprise illegal immigrants.
The lion’s share goes to reimburse hospitals for delivering babies for women who show up in their emergency rooms, according to interviews with hospital officials and studies.
(update: the video of the town hall has been removed from YouTube for whatever reason, but I have the transcript below anyway)
Last night on the Last Word with Lawrence O'Donnell, Democratic U.S. Senator and Presidential candidate Kamala Harris took her fourth (or fifth) shot at explaining exactly where she stands on Medicare for All and the elimination of private primary heatlh insurance.
As I've noted (mostly on Twitter...I just checked and it looks like I haven't written much about it on the site aside from a quick mention here), Harris has struggled to explain her position in several town hall appearances; she'll boldly stated that she supports "Medicare for All", but then stumbles when it comes to the "elimination of private insurance" issue.
The Governor will take immediate action by creating a subsidy program to reduce by 20 percent the monthly premiums for Minnesotans who receive their insurance through MNSure. This subsidy will be applied directly against a consumer’s premiums. This proposal provides relief to Minnesotans with incomes over 400 percent of the federal poverty level do not qualify for the federal premium tax credit which helps lower the costs of health insurance premiums. Up to 80,000 people could participate in the program, reducing the out-of-pocket costs of their health insurance premiums.
Covered California Announces Grants to Community-Based Organizations Across California in Preparation for 2020 and Beyond
Community-based organizations and clinics will receive a total of $6.3 million in grant funding to help people enroll in quality health care coverage.
The 105 organizations reflect California’s diversity and will target populations that are hard to reach, uninsured and eligible for financial help through Covered California.
Approximately 89 percent of Californians live within a 15-minute drive of these community-based organizations.
Covered California announced Friday that it intends to partner with 105 community-based organizations to educate consumers about their health care options, offer in-person enrollment and renewal assistance and provide ongoing support on how to get the best value from their health plan. The Navigator grants announced are part of Covered California’s ongoing commitment to support robust marketing and outreach, including working with trusted organizations throughout the state to help hard-to-reach people understand this new era of health care.
Virginia is traditionally the first state to release their preliminary individual (& small group) market healthcare policy rate changes, but this year the state insurance regulatory body delayed the initial deadline by a couple of weeks. As a result, three other states (Maryland, Vermont and Oregon) beat Virginia to the punch this year.
The extended VA deadline passed last week, however, and so I'm now able to dig up the preliminary 2020 rate filings for the ACA market. It's important to remember as always that these are preliminary requests only; some of them are bound to change at least once between now and late September, when the final rate changes are locked in and the contracts are signed for the 2020 calendar year (and Open Enrollment Period).
The Washington Health Benefit Exchange today released its Spring Health Coverage Enrollment Report detailing the more than 1.6 million customers – one in four Washingtonians – who used Washington Healthplanfinder to access their 2019 health insurance coverage.
Nearly 200,000 customers used the state’s online marketplace to purchase a Qualified Health Plan (QHP) for coverage this year, adding to the more than 1.4 million residents who connected with free or low-cost health insurance through Washington Apple Health. In several rural counties (Adams, Grant, Okanogan, Pacific and Yakima), nearly half of the population relied on Washington Healthplanfinder to enroll in a 2019 health insurance plan.
When I first watched the video, I got hung up on a different aspect of Alec Smith's story...the question of whether or not he would have qualified for tax credits via an ACA exchange policy based on his income. I reached out to Alec Smith's mother, Nicole Smith-Holt, to clarify a few things from her story, but hadn't heard back yet as of yesterday morning...and made a poor decision to post the article yesterday anyway, in which I speculated, based on the limited information in the video, that Alec may have qualified for some level of assistance after all without realizing it.
The whole post was, quite simply, wrong. It was wrong for several reasons, and I'm sorry for each of them.
I laid out several of the obvious ways in which my original post was out of line, thoughtless and showed a lack of compassion. I apologized personally to Ms. Smith-Holt, she accepted, and we had a lengthy online discussion about her son's story and what led to his death:
NOTE: Julia A. Pulver, RN, BSN, CCM has been an registered nurse for over 12 years who has spent her career working with the most at risk populations in Southeast Michigan, and is also a personal friend of mine.
UPDATED with my personal initial thoughts (see below):
A few weeks ago I noted that Michigan Republicans were pushing hard for new Democratic Governor Gretchen Whitmer to basically eliminate Michigan's unique unlimited catastrophic care requirement for no-fault auto insurance, which is the main reason our state has the highest auto insurance premiums in the country.
Whitmer and legislative Democrats don't want people to be stuck with massive auto injury medical claims, of course, and they also wanted a guarantee of significant rate reductions as well as the elimination of "redlining" (basing rates on zip codes) and other discriminatory auto insurance pricing practices, like basing premiums on credit ratings, gender and the like.
HARTFORD, CT — Democratic gubernatorial candidate Ned Lamont has much lower expectations for what he’s going to be able to do to improve the health of Connecticut residents than one might expect from a Democratic candidate this year.
Sounds like Lamont would not push for CT to reinstate the ACA individual mandate penalty:
...Does he believe everyone in Connecticut has to purchase health insurance now that it’s not mandated by the federal government?
For a good six months or so from the fall 2017 to spring 2018, retiring Republican Senator Lamar Alexander and Democratic Senator Patty Murray tried to hash out a deal which would have, had it actually been passed and signed into law, resolved some (not all) of the ACA's stabilization issues...although at a pretty ugly cost:
Reinsurance: GOOD!
Guaranteed Ad/Outreach Funding: Good! (but only necessary due to Trump cutting funding in first place)
Short-Term Plan Notifications: Good! (but only necessary because of #ShortAssPlan EO in first place)
The Fifth Circuit just officially calendared the argument for the afternoon of July 9th. Here’s the docket entry:
CASE CALENDARED for oral argument on Tuesday, 07/09/2019 in New Orleans in the West Courtroom -- PM session. In accordance with our policy, lead counsel only will receive via email at a later date a copy of the court's docket and an acknowledgment form. All other counsel of record should monitor the court's website for the posting of the oral argument calendars.. [19-10011] (SME) [Entered: 05/23/2019 11:08 AM]
While I have you, I’m attaching the excellent reply briefs filed yesterday by the growing coalition of ACA defender states led by California Attorney General Xavier Becerra as well as the brief from the U.S. House of Representatives. Both completely take apart every single one of the absurd legal arguments put forward by the Trump-Barr DOJ and Texas et al.
With the idiotic #TexasFoldEm lawsuit scheduled for oral arguments by the 5th Circuit Court of Appeals this summer, many states have been scrambling to replicate ACA protections for those with pre-existing conditions at the state level, including California, Colorado, Connecticut, Hawaii, Maryland, Nevada, New Mexico and more.
In a red state like Louisiana, unfortunately, it's not so easy...the state has a Democratic Governor, but both the state House and Senate are solidly controlled by Republicans. In addition, the Governor, John Bel Edwards, is up for re-election this November, making everything politicized, thus making it likely impossible to get anything useful through this year. Still, Gov. Edwards is trying to do something to mitigate the problem:
The numbers are all fairly small, of course, but a few noteworthy items: DC appears to have an 89% QHP enrollment retention rate as of May from the beginning of the year (they had 18,035 QHP selections as of 1/31/19), which is very good. SHOP enrollment is disproportionately high as always for DC, due to both the fact that they require all small business enrollments in the District to be handled via the exchange and the fact that members of Congress and their staff have to use the DC exchange to enroll in healthcare coverage.
Vermont Health Connect, the VT ACA exchange, doesn't post data reports very often, but they just did so, with enrollment data as of March 2019.
It's important to note that the numbers posted in the tables below include both Vermont's on and off-exchange enrollees in the individual and small group markets. It's also important to note that Vermont (like Massachusetts) merges both the individual and small group markets into the same risk pool for purposes of premium rate settings.
There are four tables...two for the Individual market (raw numbers and percentages) and two for the small group market. Perhaps the most noteworthy line is the "Reflective Silver" enrollments...those are people who took up the "Silver Switcharoo"...basically, unsubsidized individual market enrollees who switched from (or chose) on-exchange Silver plans to off-exchange Silver plans to save money on policies which are identical to the on-exchange Silver version but without the CSR premium load.
DENVER – Coloradans shopping for health insurance through Connect for Health Colorado can now preview health plans and estimate costs on their mobile devices and tablets using the award-winning Quick Cost and Plan Finder tool.
Connect for Health Colorado has optimized the tool for mobile browsing of health insurance plans as part of its technology modernization effort, which includes a suite of tools such as live chat and scheduling a call. Development is also underway to optimize the complete application for mobile devices. Making the technology consistently mobile provides a smoother user experience and supports customers who do not have immediate access to traditional desktops and laptops.
OLYMPIA, Wash. – Gov. Jay Inslee today signed Insurance Commissioner Mike Kreidler’s request legislation to end surprise medical billing, enacting arguably the strongest law in the country to protect consumers from this unfair practice.
The new law protects consumers from getting a surprise bill when they get either emergency services at an out-of-network emergency room or medical treatment at an in-network hospital or facility but are seen by an out-of-network provider.
OK, this probably won't be the most exciting Congressional hearing in the world, but it's a pretty important one both historically and for practical purposes. Any major healthcare reform bill will have to first be run through the Congressional Budget Office's scoring process...and before the CBO can do that, they first have to lay out the ground rules, which they did earlier this month.
Anyway, you can watch the hearings above; here's the details...which are pretty simple: Three CBO wonks will be testifying and questioned.
Key Design Components and Considerations for Establishing a Single-Payer Health Care System
WARNING: I can not emphasize enough just how many assumptions I'm making here. I could be ABSURDLY off at either end of the scale; the actual cost could turn out to be half as much as I project here...or twice as much. This is purely a crude, early attempt to game out the basic framework for determining the actual cost, and there's a lot of missing data, which means having to make some pretty big assumptions about the current situation, much less projecting things forward.
Had a great time discussing #MedicareForAll opposite @charles_gaba on Medicare for America for Ferndale Dems. Happy to report no one was called a neoliberal or a Bernie bro.
Your Health Idaho, the only red state standalone ACA exchange in operation since Kentucky's kynect exchange was shuttered a few years back, doesn't post updates very often, but when they do there's usually a few noteworthy items. Back in March they held a semi-annual board meeting which included a few items:
8. OPEN ENROLLMENT 2019 UPDATE
Mr. Kelly said YHI’s effectuations as of the end of January are just over 101,000 and prelim February results at 98,700. There were significant enrollment shifts between the carriers specifically with SelectHealth gaining membership due to a low-price position. Modest growth continues for the dental carriers overall with significant growth for Delta Dental. Strong seasonality is seen in effectuation trends in January and February. And as expected, the average premium is just under $500 which was anticipated with the rate increase of about 5 percent.
NY State of Health Releases 2019 Open Enrollment Report
Essential Plan and Qualified Health Plan Enrollment Reach Record Levels
ALBANY, N.Y. (May 9, 2019)—NY State of Health, the state’s official health plan Marketplace, today released detailed demographic data on the more than 4.7 million New Yorkers enrolled in comprehensive health coverage through the close of the sixth open enrollment period on January 31, 2019. Marketplace enrollment is now at its highest point ever, and Essential Plan and Qualified Health Plan enrollment reached record levels of more than 1 million people.
“It’s evident in the numbers released today that there is high demand for quality, affordable health coverage,” said NY State of Health Executive Director, Donna Frescatore. “The 2019 record enrollment levels are proof that New York’s Marketplace remains strong.”
NY State of Health 2019 Open Enrollment Report Highlights
I didn't write about this yesterday because I was both swamped and a little confused about how the various bills were being packaged and voted on, but I think I have it straightened out now.
Back on March 26th, the House Democrats formally rolled outH.R. 1884. The official title of this bill is the "Protecting Pre-Existing Conditions and Making Health Care More Affordable Act of 2019", or PPECMHCMAA, which is terrible, so I've simply shorthanded it as "ACA 2.0".
HR 1884 is actually more of a catch-all collection of a dozen or so smaller, standalone ACA improvement bills, each of which either repairs an ACA provision which has been damaged or sabotaged in the past; protects an existing ACA provision from future sabotage; or strengthens & enhances the ACA going forward.
In early 2018, Maryland state legislators introduced a bill which included a twist on the coverage mandate penalty--those who failed to sign up had another option: They could either pay the penalty or they could choose to have the penalty amount be used to automatically enroll them in the lowest-cost insurance policy available. If they qualified for ACA subsidies, those would even be baked into the equation as well. This was a clever way of softening the blow, while also increasing enrollment and helping out the ACA risk pool.
Over the past year or so I've written numerous entries about Michigan Republicans pushing through an ineffective, inefficient, cruel and pointless work requirement addition to Michigan's implementation of Medicaid expansion under the Affordable Care Act, culminating in this one:
New work requirements for people in Michigan's Medicaid expansion group could cause as many as 183,000 people to lose their coverage.
Anywhere between 9 and 27 percent of the approximately 680,000 people enrolled in the Michigan Healthy Plan - or 61,000 to 183,000 recipients - could be kicked of the rolls.
That's up to three times what was estimated by the House Fiscal Agency when the work requirement bill was passed last year. The work requirements are scheduled to take effect on January 1, 2020.
Long-time readers of this site may remember that I have a "special place" in my heart (more like in the pit of my stomach) for Ralph Hudgens, the now-former Georgia state Insurance Commissioner, ever since I read about this ugly incident way back in 2013:
“Let me tell you what we’re doing (about ObamaCare),” Georgia Insurance Commissioner Ralph Hudgens bragged to a crowd of fellow Republicans in Floyd County earlier this month: “Everything in our power to be an obstructionist.”
After pausing to let applause roll over him, a grinning Hudgens went on to give an example of that obstructionist behavior, this one involving so-called “navigators” who are being hired to guide customers through the process of buying health insurance on marketplaces, or exchanges, set up under the federal program.
Salem, OR—Oregon consumers can get a first look at requested rates for 2020 individual and small group health insurance plans.
In the individual market, seven companies submitted rate change requests ranging from an average 3.2 percent decrease to an average 13.5 percent increase, for an average of 3.3 percent. In the small group market, nine companies submitted rate change requests ranging from an average 0.3 percent decrease to an average 13.1 percent increase, for an average of 8.7 percent.See the chart for the full list of rate change requests.
“It’s early in the process, but we are encouraged to see carriers providing more options to Oregonians by expanding into both rural and coastal communities, and the market stabilizing in spite of uncertainty at the federal level,” said Insurance Commissioner Andrew Stolfi. “Now it is time to start our open and thorough review process that allows Oregonians to provide input on the filings that affect them.”
Last year, the two insurance carriers offering individual market policies in Vermont, BCBS and MVP, originally requested rate increases averaging 7.5% and 10.9% respectively, or a weighted average of 8.6%. These were eventually whittled down to 5.8% and 6.6% respectively, for a weighted average increase of 6.1% in 2019.
It's important to keep in mind that Vermont is one of only two states (the other is Massachusetts) which merges their Individual and Small Group risk pools into one.
Two states in two days...just 24 hours after the Washington State Insurance Commissioner pulled the plug on the "Aliera Healthcare" and "Trinity Healthshare" healthcare sharing ministries for fraud, the New Hampshire Insurance Dept. is issuing a similar warning (although they don't appear to be actually shutting the operation down just yet):
Consumer Alert on Potential Unlicensed Health Insurance Company
CONCORD, NH – As a result of a recent Georgia court order, the New Hampshire Insurance Department is advising consumers that Aliera, a company that markets itself as a health care sharing ministry, may be operating illegally in New Hampshire.
A health care sharing ministry is an organization that facilitates sharing of health care costs between individual members who have common ethical or religious beliefs in the United States. A health care sharing ministry does not use actuaries, does not accept risk or make guarantees, and does not purchase reinsurance polices on behalf of its members.
Members of health care sharing ministries are exempt from the individual responsibility requirements of the Patient Protection and Affordable Care Act, often referred to as Obamacare. This means members of health care sharing ministries are not required to have insurance as outlined in the individual mandate.
Bottom line: I was pretty damned close, coming within 2% of the actual average premium in 27 states and within 5% in 42 states. Nationally, I was off by 2.0%, projecting an average monthly premium of $611 vs. the $599 actual average.
Every year for 4 years running, I've spent the entire spring/summer/early fall painstakingly tracking every insurance carrier rate filing for the following year to determine just how much average insurance policy premiums on the individual market are projected to increase or decrease.
The actual work is difficult due to the ever-changing landscape as carriers jump in and out of the market, their tendency repeatedly revise their requests, and the confusing blizzard of actual filing forms which sometimes make it next to impossible to find the specific data I need.
The actual data I need to compile my estimates are actually fairly simple, however. I really only need three pieces of information for each carrier:
To improve affordability and access to health care, the Governor's Budget proposed subsidies to help more low and middle class Californians afford health coverage through Covered California.
About three weeks ago I noted that the Nevada state Senate had passed a bill which locks in many of the ACA's patient protections at the state level, just in case the idiotic #TexasFoldEm lawsuit prevails and the ACA is repealed after all.
Nevada stands to become the fifth state to fully incorporate the federal Affordable Care Act’s protections for patients with pre-existing conditions into state law after unanimous passage of a bill Tuesday in the state Senate.
"Fully incorporate" isn't quite accurate; as I noted with the Senate version, it looks like the three most important ones are covered (Guaranteed Issue, Community Rating and the ACA's 10 Essential Health Benefits), along with a pre-ACA law letting young adults stay on their parents plan until age 24 (but only if they're unmarried and enrolled in school).
HELENA — Gov. Steve Bullock has signed legislation meant to lower premiums for Montana customers who receive health insurance through the Affordable Care Act’s individual marketplace.
Bullock signed the bill Tuesday creating a reinsurance program to help reimburse insurers for high-cost claims so those costs aren’t included in determining individual marketplace premiums for the following year.
U.S. health officials also must approve the plan, which is estimated to offset 2020 premium increases by 10% to 20%.
UPDATE 11/29/19: This horrific and batshit insane Ohio bill is making the news again six month later thanks to a new Guardian article about it.
The only silver lining I can find here is that the bill doesn't appear to have made any further progress in that time--according to the official Ohio Legislature website, so far it's only been "introduced" and "referred to committee", and those happened back in April. The Guardian article has the number of co-sponsors the same as it was in May as well (19, plus the primary sponsor of the bill).
UPDATE: It's been pointed out that the Supreme Court has ruled that minors can't receive the death penalty, so I guess that means "only" life in prison for them. If they're 18 or older, however...
On the other hand, several people have noted that an 11-year old pelvis isn't generally developed enough to even deliver a baby safely, along with other health risks, so it could very well be a death sentence regardless, so I'm leaving the headline as is.
In the far simpler days of 2001, when the President of the United States didn't suck up to genocidal dictators and thank Russia for helping him win the Electoral College, an episode of The West Wing aired entitled "The Indians in the Lobby".
The Trump administration may alter the way it determines the national poverty threshold, putting Americans living on the margins at risk of losing access to welfare programs.
Michigan is the most expensive state for car insurance for the sixth consecutive year.
The Wolverine State is in a league of its own when it comes to car insurance with an average annual premium that is $313 higher than that of Louisiana, which ranked second. A Michigan car insurance policy averages $2,611, which is almost 80 percent higher than the national average of $1,457.
Louisiana remained in second place for the third year in a row, while Florida secured third place. Oklahoma and Washington D.C. rounded out the top five.
In most cases, a high number of uninsured drivers combined with less than stellar weather and high population density led these states onto the most expensive states for car insurance list.
One of the great strengths and dangers of the ACA is that it includes tools for individual states to modify the law to some degree by improving how it works at the local level. The main way this can be done is something called a "Section 1332 State Innovation Waiver":
Section 1332 of the Affordable Care Act (ACA) permits a state to apply for a State Innovation Waiver to pursue innovative strategies for providing their residents with access to high quality, affordable health insurance while retaining the basic protections of the ACA.
Last September I noted that North Dakota was considering going one of two ways when it comes to making a major change in their individual insurance market: EIther joining over a half-dozen other states in pushing for a reinsurance program (which I strongly support doing), or going the other way and starting to offer weaker policies without some ACA protections the way states like Idaho, Tennessee, Iowa and Kansas either already do or are in the process of doing.
Florida lawmakers approved a health insurance bill Wednesday that would require insurers keep covering pre-existing conditions if the Affordable Care Act disappears, though the bill would not keep protections in the federal law to control how much those patients can be charged.
...but quickly went off the rails after that:
The bill, Senate Bill 322, which the House approved by a 70-42 vote after the Senate passed it last week, would also expand short-term and association health plans and change requirements for “essential health benefits” covered by insurers, regardless of the status of the Affordable Care Act. It must be approved again by the Senate before it heads to Gov. Ron DeSantis for his signature.
A few minutes ago the Congressional Budget Office released a new report on a national, universal single payer healthcare system (commonly known as "Medicare for All" these days, although that's a bit of a misnomer since the proposed "Medicare for All" bills are quite different from today's definition of Medicare).
It's important to note that while this report came from the CBO, it is not a budget analysis of either the House or Senate MFA bills; it instead lays out the structural components which would be required to be in place in order to put such a system together and, I presume, in order to run such a budget analysis.
I'm swamped today between the rollouts of both the Choose Medicare Act and the revised Medicare for America Act as well as this new CBO report, so for the moment I'll just repost the summary and link to the report itself, along with a few notes as I'm able to add them:
NOTE:Back in January, I wrote up an extensive explainer about the "Medicare for America" (Med4Am) universal healthcare coverage bill introduced in December by Democratic Representatives (and Progressive Caucus members, I might add) Rosa DeLauro and Jan Schakowsky.
Yesterday, DeLauro & Schakowsky have introduced a modified, improved version of Medicare for America, with some important changes. I'm therefore posting an updated version of my January explainer of the bill, with notes about what's changed since the December version.
At the time, I noted that besides both bills including many "wish list" items which I've been hoping would be added to the ACA for several years now, Warren's Senate CHIPA bill was also noteworthy for one other reason: The list of cosponsors:
...Sanders is actually a co-sponsor of the Warren bill, as are Democratic Sens. Kamala Harris (Calif.), Maggie Hassan (N.H.), Kirsten Gillibrand (N.Y.) and Tammy Baldwin (Wis.).
NOTE: I'm adding some additional commentary to this post throughout the day, so reload it later on if you're curious about my thoughts, but I wanted to at least get the main info out there early.
Regular readers of this site know that I'm a big fan of Reps Rosa DeLauro & Jan Schakowsky's "Medicare for America" universal coverage bill, which is scheduled to be officialy re-introduced later on today (with some significant changes from the original version introduced back in December).
However, "Medicare for America" and "Medicare for All" are not the only "major healthcare reform" bills being tossed around DC these days. There's actually eight of them total (technically nine, but two of those are the House & Senate MFA versions, which are nearly identical). Of the eight, only two of them actually guarantee 100% universal healthcare coverage, which is part of the reason #MFA and #Med4Am receive so much attention.
