Charles Gaba's blog

The good news is that RateReview.HealthCare.Gov has posted the preliminary 2024 rate filing summaries for every state, making it much easier to pin down which carriers are actually participating in the individual & small group markets next year, as well as what the carriers average requested rate changes are in states which don't publish that data publicly (or which make it difficult to track down if they do).

The bad news is that in many of those states, acquiring the actual enrollment data is even more difficult, as their rate filings tend to be heavily redacted. Alabama falls into this category.

Back in late 2021, Colorado launched their own new, state-based ACA financial subsidies on top of federal subsidies which have already been enhanced (at least through the end of 2025) via the American Rescue Plan and Inflation Reduction Act:

The financial help you can get to lower your out-of-pocket costs are healthcare discounts called Cost-Sharing Reductions. Connect for Health Colorado is the only place you can apply for financial help to lower the cost of private health insurance. Due to the American Rescue Plan, Coloradans are now eligible for more savings than ever before.

Consider a Silver plan if your Health First Colorado (Medicaid) coverage recently ended or your income is over the limit to qualify

Connect for Health Colorado launched a new state-funded program recently to provide even more healthcare savings to people shopping on the Marketplace for 2022 whose income is just over the limit to receive Health First Colorado (Medicaid) and who enroll in a Silver-level plan.

Medicaid Unwinding

It's been over six weeks since the last time I checked in on how many Americans had lost Medicaid or CHIP coverage due to the ongoing Medicaid Unwinding process playing out nationally. At the time, "only" 612,000 people had been confirmed to have lost coverage purely due to procedural/red tape reasons (as opposed to others who lost coverage after being determined ineligible any longer).

The Kaiser Family Foundation (KFF) has taken up the mantle on this front, and the data so far, while still limited, is pretty much as bad as many healthcare advocates feared. Since then, a lot more data has been collected and the numbers have grown dramatically:

via the Centers for Medicare & Medicaid Services (CMS):

In April 2023, 94,151,768 individuals were enrolled in Medicaid and CHIP.

  • 87,062,629 individuals were enrolled in Medicaid in April 2023, an increase of 348,055 individuals from March 2023.
  • 7,089,139​​​​​​​ individuals were enrolled in CHIP in April 2023, a decrease of 73,121 individuals from March 2023.
  • Since February 2020, enrollment in Medicaid and CHIP has increased by 23,276,699 individuals (32.8%).
    • Medicaid enrollment has increased by 22,982,836 individuals (35.9%).
    • CHIP enrollment has increased by 293,863 individuals (4.3%).

Medicaid enrollment likely increased due to the COVID-19 PHE and Medicaid continuous enrollment condition under the Families First Coronavirus Response Act (FFCRA), which started in March 2020 and ended on March 31, 2023.

The Missouri Insurance Dept. has posted their preliminary 2024 single risk pool filings for the individual and small group markets.

Not a whole lot stands out to me other than Cigna apparently dropping out of the states indy market and Humana pulling out of the small group market. Otherwise, neither market has rate changes which seem terribly surprising--they come to a weighted average increase of 4.3% for individual market plans and 6.6% for the small group market.

As always, these are subject to state regulatory review and approval.

Via the Colorado Department of Regulatory Agencies (I accidentally deleted the original blog post so I'm recreating it using the graphics below).

The most noteworthy developments below are that in addition to Friday, Oscar and Bright Health Plans all leaving the Colorado market (as documented/reported on several times earlier this year), it looks like Anthem is reducing its offerings on the individual market, while Aetna and Humana both appear to be dropping out of the states small group market.

Update: Correction, apparently I misread that about Anthem; they have the same total number of plans available after all...not sure how I messed that up; apologies. Their Rocky Mountain division is offering off-exchange policies only, abut aren't listed on CO DARA's summary for whatever reason.

In any event, the weighted average increase being requested is 9.8% on the individual market and 10.6% for the small group market.

Back in February, I wrote about how the state of Georgia, in an eyebrow-raising move, announced that they were moving from the federal ACA exchange (HealthCare.Gov) onto their own state-based ACA exchange.

While numerous other states have already done the same thing (and several more are in the process of doing so as well), Georgia's move to their own enrollment platform was especially noteworthy for two reasons:

First, because it represents as complete 180-degree policy turn from their prior attempts (over the course of several years) to eliminate any formal ACA exchange (federal or state-based) in favor of outsourcing it to private insurance carriers & 3rd-party web brokers.

Secondly, because of the timeframe involved:

via the Idaho Dept. of Insurance:

Each year, the Idaho Department of Insurance posts rate changes of individual and small group health insurance products so consumers can review and provide comments on the proposed increases.  Insurance companies submit proposed rates for the upcoming calendar year to the Department, along with descriptions and justifications for why the rates are reasonable and not excessive.  

The Department of Insurance is seeking public input for rate changes of individual and small group health insurance products to improve insurer accountability and transparency.  By following the links below, the public can access a summary of the increase amounts and the carrier justifications for the rates.  Please submit any comments to the Department for consideration.

Preliminary Rates - 2024

Please choose one of the categories to proceed:

Back in March, after years of failed and stalled attempts to get it passed, the North Carolina legislature finally pushed ACA Medicaid expansion over the line to be signed into law by Democratic Governor Roy Cooper.

As for when the program would actually go into effect, however...that's been something of a mystery for awhile now. Apparently the wording of the legislation ties it in with it being included in the general state budget, which hasn't happened yet. As a result, no one seems to be sure whether NC Medicaid expansion will kick off in October, November, December or January of next year.

However, the state's Health & Human Services Dept. has decided to take a proactive, optimistic stance:

State Takes Action To Start Medicaid Expansion Oct. 1; Launch depends on General Assembly acting by Sept. 1

via New York State of Health:

  • Nearly Three Quarters of New Yorkers Enrolled in Medicaid, Child Health Plus or the Essential Plan Have Renewed Their Coverage by the June Deadline; Renewal Strategies Are Working; Others Still Have Time to Act
  • New York Outperforming National Average as Reported by KFF
  • Monthly Dashboard Tracks Renewal Status, Demographics, and State Program Transitions During Public Health Emergency Unwind  

ALBANY, N.Y. (July 18, 2023) – The New York State Department of Health today released the first issue of New York’s Public Health Emergency Unwind Dashboard, a monthly report reflecting data on renewal status, demographics, and program transitions for public health insurance enrollees, which shows renewal outreach strategies are working.  The report indicates that roughly 72 percent of New Yorkers enrolled in Medicaid, Child Health Plus or the Essential Plan renewed their coverage before the June deadline to re-enroll and those who haven’t still have time to act to avoid potential lapses in coverage. As reported by KFF, the national renewal rate for states reporting data is 59 percent.