The DC exchange has this frustrating habit where they do issue regular, easy-to-read enrollment reports...but they keep using cumulative numbers since 2013 in those reports. I honestly have no idea why they do it this way; since people are constantly moving on and off of different types of coverage, and even those who keep the same policy have to renew those policies every year anyway, so reporting the multi-year cumulative number of enrollments makes about as much sense to me as Ford reporting how many cars they've sold since 1903.
However, by simply comparing the cumulative numbers against older cumulative numbers, I can use the difference to see how things are going during the off season, like so:
More Than 225,000 People Enrolled in Health Coverage Through DC Health Link from October 1, 2013 to June 10, 2016
OK, this blows. Last year, you'll recall that about a dozen of two dozen ACA-created Co-Ops melted down, one after another, throughout August, September and October. There were a lot of reasons behind their failure, but one of the biggest ones had to do with the infamous Risk Corridor Massacre brouhaha.
As I noted last fall, "Risk Corridors" were one of three programs put into place by the federal government which are intended to smooth the way for the insurance carriers as they try to navigate the rocky, uncertain terrain of the new health insurance landscape under the ACA. Two of the programs--Risk Corridors and Reinsurance--were never intended to last more than the first 3 years of the exchanges anyway (that is, they've always been scheduled to be discontinued at the end of 2016). Unfortunately, due to the GOP yanking the rug out from under the Risk Corridor program, only 13% of the money which was supposed to be paid out to the eligible carriers ever was last year, causing several co-ops (and at least one private carrier) to go belly-up...and leaving many of the remaining co-ops on very shaky financial ground.
The third program, "Risk Adjustment", is permanent. Risk Corridors were set up to shift funds from carriers which lost more than a certain amount of money from carriers which earned more than a certain amount of money. Risk Adjustment, on the other hand, is designed to shift funds from carriers which happened to enroll lower-risk enrollees to those which enrolled higher-risk enrollees. This may sound similar on the surface, and I'm assuming there's quite a bit of overlap between the two in practice, but that's an important distinction.
It's been nearly 2 weeks since the last update to my 2017 Requested Rate Hike project. While I've locked down the requested increases for 35 states and the District of Columbia, the remaining 15 states seem to be pretty quiet about their 2017 rate filings. Today, however, I'm able to fill in at least half of the puzzle for one state: South Dakota.
To the best of my knowledge, there are only 6 carriers offering policies on the SD indy market: Avera, DakotaCare (off-exchange only), Sanford, SD State Medical, Celtic and Wellmark BCBS. It's worth noting that DakotaCare is in the process of being bought out by Avera, but I'm not sure whether they'll be submitting separate filings or not.
It turns out there were actually two ACA-related federal cases ruled on today...and the second one went against the Obama administration. This one has to do with "Fixed Indemnity plans". I admit to not knowing much about these, so here's an explainer courtesy of healthinsurance.org:
DEFINITION: A fixed-dollar indemnity plan is a type of medical insurance that pays a pre-determined amount on a per-period or per-incident basis, regardless of the total charges incurred. Plans might pay $200 upon hospital admission, for example, or $100 per day while a person is hospitalized.
Last night I wrote a pretty extensive post about the Q1 2016 ACA Exchange Effectuated Enrollment Report, which breaks out the effectuated enrollment numbers as of the end of March. This is a follow-up post with some additional oddball items of interest. I'll probably add some things, so check back later for updates.
First up: While the national net attrition rate from the end of open enrollment through the end of March was around 12.6% (11.08 million vs. 12.68 million), the drop-off rate ranged widely state to state. Here's a table breaking this out. The net attrition is over 20% in 5 states and DC and between 15-20% in 5 more states, but is under 10% in 14 states. In fact, Rhode Island saw a net increase in effectuated enrollees from January through the end of March.
With all of the lawsuits against the ACA flying around over the years, there are some which I haven't even heard about. One of them just came to my attention this morning (thanks to Nicholas Bagley for the heads' up): The State of West Virginia vs. the HHS Dept:
Elbert Lin, Solicitor General, Office of the Attorney General for the State of West Virginia, argued the cause for appellant. With him on the briefs were Patrick J. Morrisey, Attorney General, and Julie Marie Blake, Assistant Attorney General.
Lindsey Powell, Attorney, U.S. Department of Justice, argued the cause for appellee. With her on the brief were Benjamin C. Mizer, Principal Deputy Assistant Attorney General, and Alisa B. Klein and Mark B. Stern, Attorneys.
Before: KAVANAUGH and WILKINS, Circuit Judges, and SILBERMAN, Senior Circuit Judge.
Opinion for the Court filed by Senior Circuit Judge SILBERMAN.
Last year, there was roughly a 13% net attrition rate from the end of the 2015 open enrollment period and the end of March, from 11.7 million down to about 10.2 million over a 5-week period (2/22/15 - 3/31/15).
This year, as of the end of the 2016 Open Enrollment Period on January 31st, just shy of 12.7 million people (12,681,874 to be precise) had selected Qualified Health Plans (QHPs) via either the federal exchange (HealthCare.Gov) or one of the dozen or so state-based exchanges (Covered California, kynect, MNsure and so forth). A flat 13% drop should have resulted in the number still effectuated as of the end of the first quarter (3/31/16) having dropped to just barely over 11.0 million (11,033,230 to be precise).
While I was generally supportive of the idea overall, I also concluded that:
For me, however, ColoradoCare addresses many of the criticisms I've had of Bernie's plan. I'm not necessarily "endorsing" it (I still have a lot more to learn about the details and the criticisms before I can do so), but the bottom line is that it's more realistic and far better thought out than Bernie's national plan is. This is the best opportunity for achieving single payer that you're likely to see anytime soon.
The Kaiser Family Foundation released their monthly tracking poll today. In addition to the usual questions about the ACA (spoiler: Republicans generally don't like it, Democrats generally do, and there's absolutely no consensus about what the public wants to do about it anyway), they also mixed things up a bit by asking timely questions about the Zika virus and increasing insurance policy premiums.
Here's the one which I find the most depressing...but also the least surprising:
Overall, nearly nine in ten (88 percent) Americans say they are concerned about increases in the amount people pay for their health insurance premiums. This is followed closely by the percent who are concerned about increases in the costs of deductibles (85 percent), increases in what the nation as whole spends on health care (83 percent), and increases in prescription drug costs (82 percent). Fewer but still large majorities of insured Americans are concerned about increases in spending on government health insurance programs (74 percent) and increases in the amount employers pay for their employees’ premiums (71 percent).
A special session for Medicaid expansion will have to wait, Gov. Dennis Daugaard announced Wednesday.
After a weeks-long effort to lobby enough lawmakers to get the proposal approved in the Statehouse, Daugaard announced in a statement that he wouldn't call lawmakers back to Pierre.
Citing the upcoming presidential election that could result in substantial changes to the federal health insurance program for needy people, Daugaard said a special session was off the table.
“We have a good plan that would increase health care access at no additional state cost and guarantee that the federal government won’t shift its responsibility to pay for Native American health care to the state,” Daugaard said in a statement. “Still, I have heard from legislators that they would like more time to study this plan and in particular want to wait to consider the issue until after the presidential election. For that reason, I will not be calling a special session to take up this issue.”
