The headline above is actually a bit questionable; I'm not 100% sure whether the second rate filings are final/approved or not. They're lower than the "requested" rates listed on the federal Rate Review website, and the filing forms say these are "approved," but there hasn't been a formal press release issued either so it's hard to be sure.
In any event, the weighted average unsubsidized rate increase for 2023 looks like it's 4.4% on the individual market (down from the earlier 5.9% requested hikes), while the small group market carriers are requesting average increases of 4.1%.
I wasn't expecting New York to be the first state to publicly release their final/approved rate filings, but so be it (in fact, they're just the first state I'm aware of to do so).
Virginia has an extremely robust, competitive individual & small group insurance market...and in 2023 it's getting even more competitive, with what appear to be two new carriers joining the individual market (Aetna Health Inc. and Anthem EPO), although Anthem is only offering off-exchange policies (why??) while Bright Health Insurance appears to be dropping out of the individual market (which is a common theme for Bright this year...)
Virginia used to be one of the first states to release their preliminary rate filings for the upcoming year, but for the past year or two it's been among the later ones. I don't know how much of this is due to COVID-related issues or if it's just an internal policy change for some other reason. Regardless, as a result, VA also happens to be the first state to release their annual rate filings since the Inflation Reduction Act (which includes a 3-year extension of the enhanced ACA subsidies) passed both the U.S. House and Senate.
Having said that, I'm pretty sure these filings still reflect the pre-IRA world, since most of the forms appear to have been submitted to the SERFF database back in May. Plus, President Biden didn't actually sign the bill into law until a few days ago, so any filing changes based on it couldn't actually be officially considered until after that happened.
Instead, the most significant thing to impact Virginia carriers 2023 filings is the state's Section 1332 Reinsurance Waiver. I wrote about this way back in 2018 when the state was originally considering applying for one, but it sounds iike it didn't actually go through until 2021 and doesn't actually go into effect until this January:
During 2021, the Virginia General Assembly passed HB 2332, the Commonwealth Health Reinsurance Program, which was signed into law on March 31, 2021 as Chapter 480, of the 2021 Virginia Acts of Assembly. This bill requires the State Corporation Commission to submit a waiver request for federal approval to establish a reinsurance program beginning January 1, 2023.
Section 1332 of the Affordable Care Act permits a state to apply for a State Innovation Waiver (also referred to as a section 1332 waiver) to pursue innovative strategies for providing residents with access to high quality, affordable health insurance while retaining the basic protections of the ACA. The program also provides pass-through funding to the state for federal savings from approved initiatives.
The proposed reinsurance program would be funded through state general funds and federal pass-through funding provided under the waiver. It would reimburse carriers in the individual health insurance market for a proportion of the claims of covered individuals with high annual costs. The program is designed to increase affordability in the individual market with a statutory goal of decreasing premiums by up to 20 percent.
...On May 18, 2022, federal reviewers issued a letter approving Virginia’s State Innovation Waiver application to establish the Commonwealth Health Reinsurance Program (CHRP) for an initial period of up to five years, beginning in 2023. Per enactment language, the remaining Virginia statutes establishing the CHRP will become effective on June 17, 2022, 30 days after the Commission provided notice of federal approval.
The CHRP is designed to operate as a traditional reinsurance program by reimbursing ACA individual market health insurers for a percentage of an enrollee’s claims costs exceeding a specified threshold (or “attachment point”) and up to a specified ceiling (or “reinsurance cap”). Specifically, in 2023, the approved program would reimburse claims between an attachment point of $40,000 and an estimated $155,000 cap with a coinsurance rate of 70%. This program is projected to reduce individual premiums in the ACA marketplace by 15.6% for plan year 2023.
However, it doesn't look like it's going to have quite as dramatic an impact on unsubsidized rates in 2023 as they had hoped at the time; on average, unsubsidized premiums are expected to drop by around 13% rather than the 15.6% anticipated in the waiver application.
On the other hand, these are still only preliminary filings; they might be further reduced after regulatory review...and of course the fact that the IRA was passed and signed into law means that the enhanced subsidies will continue for at least three more years, which itself should have some impact on the final rate filings.
One other small factor: There's a bit of confusion on the actual average rate change for four of the carriers (CareFirst BlueChoice, GHMS, Kaiser and Optima Health), all of which show different average reductions in the actual filing forms than are shown on the federal rate review website.
Meanwhile, the small group market in Virginia doesn't appear to have any such drama going on; 2023 premiums will go up an average of around 6.4%, assuming the filings are approved as is.
The Inflation Reduction Act extends the increased financial help initially provided by the American Rescue Plan through the end of 2025.
The increased subsidies expanded health care coverage, leading to record enrollment in California and across the nation, and lowered insurance costs for people who signed up through an Affordable Care Act marketplace.
The landmark legislation will continue to make coverage more affordable at a time when many individuals and families are facing increased challenges in the current economic environment.
(LANSING, MICH) Michigan Department of Insurance and Financial Services (DIFS) Director Anita Fox is applauding Congress and the Biden Administration for enacting the Inflation Reduction Act which, in part, will extend increased Health Insurance Marketplace premium subsidies for another three years. These subsidies, first expanded by the American Rescue Plan, have enabled 4 out of 5 enrolled Americans to find health insurance for less than $10 per month on HealthCare.gov.
This just in via the New Jersey Dept. of Banking & Insurance (via email for now):
Statement from New Jersey Department of Banking and Insurance Commissioner Caride on President Biden’s Enactment of the Inflation Reduction Act
TRENTON – New Jersey Department of Banking and Insurance Commissioner Marlene Caride today released the following statement on the signing by President Biden of the Inflation Reduction Act:
With the signing of the Inflation Reduction Act, President Biden and Congress have preserved a lifeline to health insurance for millions of Americans. For New Jersey, this means the preservation of record levels of financial help that have made health insurance through Get Covered New Jersey more affordable for hundreds of thousands of New Jersey residents.
ST. PAUL, Minn.—Today, President Biden signed into law a sweeping investment in health care affordability for Americans that will help keep health care costs in check for over 70,000 Minnesotans.
The new federal legislation, called the Inflation Reduction Act, extends enhanced subsidies for private health plans purchased through MNsure, Minnesota’s health insurance marketplace. First introduced in 2021 as part of the American Rescue Plan, the enhanced subsidies made existing tax credits more generous and expanded eligibility for tax credits to include more middle-income families. The average annual savings for MNsure enrollees is $6,100 per household for 2022.
DENVER— Today, President Biden signed the Inflation Reduction Act into law. In addition to tackling issues such as climate change, health care and prescription drug costs, the legislation will extend the expansion of Affordable Care Act marketplace premium tax credits through 2025.
Connect for Health Colorado’s Chief Executive Officer, Kevin Patterson, released the following statement:
The bill extends enhanced subsidies for three more years and helps bring down costs for Connecticut residents who need financial help to pay for the cost of their health insurance premiums
HARTFORD, Conn. ( August 12, 2022) — Access Health CT (AHCT), Connecticut’s official health insurance marketplace, today announced Connecticut residents who purchase health insurance on the exchange will continue to receive enhanced subsidies thanks to the Inflation Reduction Act (IRA). The enhanced subsidies, which were set to expire at the end of the year, are advanced premium tax credits that help Connecticut residents pay for the cost of their monthly health insurance payments. This financial help is now extended for three more years.
Pennsylvanians can access these savings and enroll in 2022 coverage at pennie.com if they are experiencing a qualifying life event, Pennie’s Open Enrollment begins November 1st and runs until January 15th for 2023 coverage.
Harrisburg, PA – August 16, 2022 –
The Inflation Reduction Act (IRA) passed earlier this month by Congress and signed into law today by President Biden, will save hundreds of thousands of Pennsylvanians from experiencing increases in what they pay for their health coverage through Pennie next year. The IRA extends the enhancements to Affordable Care Act (ACA) premium subsidies originally created by the American Rescue Plan (ARP) which were set to expire at the end of the year. Thanks to this new law, Pennsylvanians will be able to receive these enhanced subsidies through 2025.
Hearing Aids: Hearing aids are so expensive that only 14% of the approximately 48 million Americans with hearing loss use them. On average, they cost more than $5,000 per pair, and those costs are often not covered by health insurance. A major driver of the expense is that consumers must get them from a doctor or a specialist, even though experts agree that medical evaluation is not necessary. Rather, this requirement serves only as red tape and a barrier to more companies selling hearing aids. The four largest hearing aid manufacturers now control 84% of the market.
In 2017, Congress passed a bipartisan proposal to allow hearing aids to be sold over the counter. However, the Trump Administration Food and Drug Administration failed to issue the necessary rules that would actually allow hearing aids to be sold over the counter, leaving millions of Americans without low-cost options.
An estimated additional 34,000 people are now eligible for essential care for a full year after pregnancy, thanks to the American Rescue Plan and the Biden-Harris Administration’s efforts to strengthen maternal health coverage.
Today, the U.S. Department of Health and Human Services (HHS), through the Centers for Medicare & Medicaid Services (CMS), approved the extension of Medicaid and Children’s Health Insurance Program (CHIP) coverage for 12 months after pregnancy in Hawaii, Maryland, and Ohio. As a result, up to an additional 34,000 people annually – including 2,000 in Hawaii; 11,000 in Maryland; and 21,000 in Ohio – will now be eligible for Medicaid or Title XXI-funded Medicaid expansion CHIP coverage for a full year after pregnancy. With today’s approval, in combination with previously approved state extensions, an estimated 318,000 Americans annually in 21 states and D.C. are eligible for 12 months of postpartum coverage. If all states adopted this option, as many as 720,000 people across the United States annually would be guaranteed Medicaid and CHIP coverage for 12 months after pregnancy.
UPDATE 8/16/22: President Biden officially signed the Inflation Reduction Act into law this afternoon!
Annnd there you have it: In a strict party-line 220-207 vote, the Inflation Reduction Act (a stripped-down version of the Build Back Better Act, which was originally branded as the American Families Plan) finally passed the U.S. House of Representatives after passing the U.S. Senate 51-50 (with Vice-President Harris as the tie-breaking vote) on Sunday. I presume President Biden will be holding a big, formal signing ceremony sometime next week.
A big chunk of the bill is related to climate change, of course, and another large chunk of it is purely related to deficit reduction. As for the healthcare provisions, here's a summary of what's included:
Going forward, it looks like I'm going to have to do some educated guesses for a lot of carrier enrollment numbers for the states which haven't made their full 2023 rate filing data publicly available either on their own insurance dept. sites or even via the SERFF database.
The federal Rate Review site includes the average rate increases for each individual carrier, but most of the enrollment data is still redacted.
Texas' annual health insurance rate filings are kind of a mixed bag in terms of transparecy. Hardly any of the carriers have Uniform Rate Review Template (URRT) forms or Rate Filing Justification Form Part II available (these are the documents which generally include the actual number of people enrolled in the policies for each market for that insurance carrier), and the Actuarial Memorandum (Part III) is heavily redacted for most of them, making it very difficult to lock in the actual enrollment numbers.
The Georgia Access model would eliminate the use of HealthCare.gov, transitioning consumers to decentralized enrollment through private web-brokers and insurers. The state would establish its own subsidy structure to allow for 1) the subsidization of plans that do not comply with all the ACA’s requirements; and 2) enrollment caps if subsidy costs exceed federal and state funds.
There's not a single part of the paragraph above which shouldn't be setting off major alarms:
Going forward, it looks like I'm going to have to do some educated guesses for a lot of carrier enrollment numbers for the states which haven't made their full 2023 rate filing data publicly available either on their own insurance dept. sites or even via the SERFF database.
The federal Rate Review site includes the average rate increases for each individual carrier, but most of the enrollment data is still redacted.
In South Dakota, there are only 2 carriers offering individual market coverage next year. I have hard enrollment numbers for one of them; for the other, I'm assuming equal enrollment for each based on a rough assumption of ~42,000 total indy market enrollees statewide.
Assuming this is fairly close, that would put the weighted average rate increases at roughly 10.5%. If not...well, the unweighted average would be 11.3%.
For the small group market, I don't even have a decent total market size to base an estimate off of, so I have to go with the unweighted average of 4.3%.
Going forward, it looks like I'm going to have to do some educated guesses for a lot of carrier enrollment numbers for the states which haven't made their full 2023 rate filing data publicly available either on their own insurance dept. sites or even via the SERFF database.
The federal Rate Review site includes the average rate increases for each individual carrier, but most of the enrollment data is still redacted.
In Montana, there are only 3 carriers offering individual market coverage next year. I have hard enrollment numbers for one of them; for the other two, I'm assuming equal enrollment for each based on a rough assumption of ~52,000 total indy market enrollees statewide.
Assuming this is fairly close, that would put the weighted average rate increases at roughly 8.8%. If not...well, the unweighted average would be 9.3%.
For the small group market, I don't even have a decent total market size to base an estimate off of, so I have to go with the unweighted average of 4.9%.
Going forward, it looks like I'm going to have to do some educated guesses for a lot of carrier enrollment numbers for the states which haven't made their full 2023 rate filing data publicly available. The federal Rate Review site includes the average rate increases for each individual carrier, but most of the enrollment data is still redacted.
In Oklahoma, there are 7 carriers offering individual market coverage next year (it looks like Bright Health Insurance is dropping out). I have hard enrollment numbers for 4 of them; for the other three, I'm assuming equal enrollment for each based on a rough assumption of ~190,000 total indy market enrollees statewide.
Assuming this is fairly close, that would put the weighted average rate increases at roughly 8.8%. If not...well, the unweighted average would be 9.0% anyway, so this is at least somewhat more accurate.
For the small group market, I don't even have a decent total market size to base an estimate off of, so I have to go with the unweighted average of 8.1%.
Here's the preliminary 2023 rate filings for Iowa's individual & small-group markets. Unfortunately, I only have the enrollment data for the two smaller carriers on the individual market (and none for the small group market), but based on my estimate of Iowa's total ACA-compliant individual market, I can make an educated guess as to the weighted average, which should be roughly 2.0%.
Unfortunately I can't do the same for the small group market; for that, the unweighted average rate increase is around 5.1%.
I should also note that Iowa also has 35,400 residents still enrolled in pre-ACA ("transitional" or "grandmothered") medical policies, with nearly all of them being via Wellmark:
Unfortuantely, Illinois is another state which doesn't make it easy to analyze annual health insurance premium rate filings.
There's no details on their insurance department website, their SERFF listings don't seem to include the actuarial memos or URRT forms, and even the federal Rate Review listings only include the average requested rate changes; the actuarial memos there are mostly heavily redacted.
Illinois' total individual market enrollment should be roughly 330,000 people. Fortunately, three of the carriers do reveal their 2022 enrollment, including the biggest one in the state (Blue Cross). This allows me to make an educated guess as the the enrollment of the other 7, which in turn means I can make an estimate of the weighted rate increase of roughly 6.9%. The unweighted average is 8.9%.
For the small group market I have to go with the fully unweighted average of 6.8%.
With all 50 Republican Senators refusing to lift a finger to fight climate change, tackle prescription drug pricing or extend the enhanced ACA subsidies for over 13 million people, Democrats have watched helplessly as two of their own Senators (Joe Manchin and Kyrsten Sinema) have repeatedly blocked or otherwise stymied efforts to get these vital measures through the Senate.
The drama appears to finally be coming to an end this weekend, however.
Last week Sen. Manchin announced that he & Senate Majority Leader Chuck Schumer had come to an agreement on a heavily modified & pared-down version of what was once called the "Build Back Better Act"...newly christened as the "Inflation Reduction Act of 2022". He then spent the past week pushing the bill heavily on TV appearances/etc, and the rest of the Democratic leadership joined in a coordinated effort to promote the bill.
Health and Human Services Secretary Xavier Becerra declared the monkeypox outbreak a public health emergency on Thursday in an effort to galvanize awareness and unlock additional flexibility and funding to fight the virus’s spread.
“We’re prepared to take our response to the next level in addressing this virus, and we urge every American to take monkeypox seriously and to take responsibility to help us tackle this virus,” Becerra said at a Thursday press briefing.
The health secretary is also considering a second declaration empowering federal officials to expedite medical countermeasures, such as potential treatments and vaccines, without going through full-fledged federal reviews. That would also allow for greater flexibility in how the current supply of vaccines is administered, Becerra said.
...Federal officials Thursday afternoon said they were still finalizing the formal declaration of a public health emergency, which would be posted on an HHS webpage.
President Biden will issue an Executive Order on Securing Access to Reproductive and Other Healthcare Services, building on actions that the Biden-Harris Administration has taken to protect access to reproductive healthcare services and defend women’s fundamental rights. The President kick off the Vice President’s first meeting of the Task Force on Reproductive Healthcare Access. At the meeting, the Cabinet will discuss their progress and the path forward to address the women’s health crisis in the wake of the Supreme Court’s decision in Dobbs v. Jackson Women’s Health Organization.
EXECUTIVE ORDER ON SECURING ACCESS TO REPRODUCTIVE AND OTHER HEALTHCARE SERVICES
Through today’s Executive Order, the President will announce actions to:
Wyoming is the smallest state and only has two carriers offering individual market policies (and just three offering small group plans). This makes it pretty simple for me.
Unfortunately, neither their insurance department website nor their SERFF filings give any indication of the enrollment numbers for any of the carriers. Fortunately, the federal rate review website does list enrollment for Blue Cross Blue Shield of Wyoming...which also has something like 95% of the individual market share in the state. By estimating the enrollment for the 2nd carrier (Montana Health Co-Op), I should be pretty close to the weighted average...a pretty ugly 18.5% average rate hike. Ouch.
It's no better on the small group side, although I don't have the actual enrollment for the other two carriers; the unweighted average is "only" an 11.9% increase, but it's over 20% for BCBSWY enrollees.
The South Carolina Insurance Dept. website isn't particularly helpful when it comes to getting the annual rate filing data for these analyses--they post a link to the federal Rate Review website and the SERFF database, but that's it...and most of the filings don't show up in SERFF, while many Rate Review database actuarial memos are all heavily redacted.
Fortunately, this year the Rate Review database has Consumer Justification Narratives for 4 of the 5 carriers participating in SC's individual market (Bright Health Co. appears to be dropping out of the state's indy market). While the fifth one is missing (Molina), I can make an educated guess as to their enrollment based on South Carolina's total individual market size, which should be roughly 300,000 people, give or take.
Based on that, it looks like SC carriers are asking for around a 10.4% average rate hike in 2023.
For the small group market, all of the actuarial memos are redacted, so all I have is the unweighted 2022 average rate changes, which comes in at +5.4%.
Utah's preliminary 2022 individual and small group market rate filings are listed below. They launched a handy new website specifically dedicated to insurance filings, which is nice to see.
Unless there's a change in the final/approved rates, unsubsidized individual market plan premiums are increasing by around 6.0% in 2023, while small group plans will go up 6.7% on average.
I can't overstate how much I wish every state was as good as Pennsylvania is at not only making their annual rate filings publicly available on the state insurance dept. website, but doing so in such a clear, simple format, while also including a consistent summary page for every carrier!
As a result of this attention to transparency and detail, I was able to put together my Pennsylvania analysis pretty quickly even though they hae a huge number of carriers on both their individual and small group markets.
Insurance Department Releases 2023 Proposed ACA Rates And Health Plans
Harrisburg, PA – Acting Pennsylvania Insurance Commissioner Michael Humphreys today released the 2023 requested rate filings for insurance plans under the Affordable Care Act. As filed, 2023 will see increased competition and more choices for consumers within some counties. Both the individual and small group rate requests will result in a moderate statewide average increase.
