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The ACA's Medical Loss Ratio rule requires insurance carriers to spend at least 80% of all individual market premiums on actual healthcare, as opposed to CEO bonuses, exotic junkets to Tahiti, marble columns in their corporate headquarters and the like. The way it works is pretty simple: If an insurance carrier ends up spending less than 80% of the premiums paid by their enrollees on actual healthcare claims in a given year, they have to pay the difference back to their customers in the form of a rebate check the following year. You can thank Senator Al Franken for this provision, and it's a good one..so good that nationally, carriers have had to return over $2.4 billion in excessive premiums to their enrollees over the past 4 years.

Unfortunately, as I noted two years ago:

So, the last day or so my email inbox & Twitter feed have been filling up with references to Bill Clinton's "Crazy System!" comments regarding the Affordable Care Act. I live in Michigan, but unfortunately couldn't make his Flint speech on Monday due to it being Rosh Hashanah.

Anyway, here's the part which made all the headlines:

Bill Clinton criticized President Barack Obama’s signature policy reform while on the stump for his wife, Democratic presidential nominee Hillary Clinton, calling Obamacare “the craziest thing in the world.”

Here's the problem with this: Clinton wasn't referring to the Affordable Care Act as a whole; he was specifically referring to people on the individual market who aren't receiving APTC assistance.

As I noted a couple of weeks ago:

Some Guy, September 8th, 2016:

Until now, I've been assuming that the vast majority--say, 99% or so--of those 7.1 million people who are enrolled in individual plans directly thorugh the carriers must be over 400% FPL, undocumented immigrants, have some other type of legal issue preventing them from enrolling on the exchanges, etc. etc.

HOWEVER, if McKinsey's statement above is accurate, this isn't the case at all.

Why? Because if 69% of the entire individual market (including GR/TR enrollees) is eligible for subsidies, that has to mean that some percentage of off-exchange enrollees are...and not just people in transitional/grandfathered plans.

  • The total market is 20.2 million people.
  • 69% of that is appx. 12.9 million people McKinsey says are eligible for APTC.

We can account for 9.4 million of those, of course; those are the 9.4 million who are receiving APTC via exchange policies.

Subtract those, and you have another 3.5 million people eligible for APTC assistance out of the 9.1 million total off-exchange enrollees (ACA, GR & TR).

h/t to Esther F. for the heads up:

Amy Goldstein at the Washington Post writes:

Evergreen Health, Maryland’s version of the innovative nonprofit insurers created under the Affordable Care Act, decided Monday to become a for-profit company to avoid the possibility of a shutdown, according to its chief executive.   

If the switch is approved as expected by federal and state officials, Evergreen’s unprecedented move will leave standing only five of the 23 co-ops, or Consumer Operated and Oriented Plans, which started nearly three years ago.

...Evergreen, which covers nearly 38,000 Marylanders, has been trying for the past year to forge an arrangement with federal health officials to stabilize its finances. It enlisted help from the state’s congressional delegation and in June filed suit against the federal government.

As noted below, only around 8,000 are on enrolled in individual ACA exchange policies; the rest are either off-exchange or small/large group coverage.

More last-minute shuffling... (h/t commenter "M E"):

Baptist Health Plan to stop selling insurance in Ky.

FRANKFORT (AP) — Baptist Health Plan says it will not sell policies in Kentucky next year, meaning about 7,000 people will have to find a new insurance provider.

Kentucky’s fourth-largest insurer notified state officials in a letter. In a news release, state officials say company President James S. Fritz said Baptist Health Plan had enrolled more people than it planned and said federal risk assessments imposed by the federal Affordable Care Act are “unsustainable.”

The company’s insurance plans sold on the state’s health exchange will be good through Dec. 31. Plans sold off the exchange will expire March 31, 2017.

The news means next year people in 59 counties will have one insurance provider selling plans on the state health exchange. Off the exchange, most counties will have two options, state officials said.

OK, this is earlier than I expected...Your Health Idaho has decided to be first out of the gate with official 2017 ACA Exchange Window Shopping: 

October 1, 2016

Preview Health and Dental Plans on Your Health Idaho

BOISE, Idaho – Starting today, Idahoans can get a preview on YourHealthIdaho.org of the 225 different health and dental insurance plans being offered on the exchange in 2017.

“Before open enrollment begins on November 1, Idahoans can preview and compare different health and dental insurance plans to figure out which one best meets their needs,” said Pat Kelly, executive director of Your Health Idaho. “There are not only more plans being offered this year than ever before, but customers can see the size of the plan’s network to get a full perspective on the choices available to them.”

Prior to the 2017 open enrollment period, health insurance carriers will reach out to their customers to inform them of any changes to their current plan, including differences in rates and deductibles.

Back in June, BCBS of Minnesota announced that they were pulling all of their PPO plans out of the state. Aside from that, and some hefty proposed rate hikes for everyone else, there hasn't been a whole lot of news out of the Land of 10K Lakes.

Today, however, they announced their approved rate increases, and the unsubsidized prices don't look pretty:

Health insurers are boosting individual market premiums by an average of 50 percent or more next year, increases that regulators say are necessary to save a market that otherwise was on the verge of collapse.

The increases were announced Friday by the state Commerce Department, and show premiums will jump even higher than proposed rates that were made public on Sept. 1.

At that point, carriers sought increases ranging from 36 percent to 67 percent. But the final average increases will range form 50 percent to 67 percent, depending on the insurer.

Here's how it actually plays out by the hard numbers:

In yesterday's New Hampshire Business Review, a reporter named Bob Sanders has written an excellent piece about the 2017 Open Enrollment Period situation in the Granite State:

As the dust settles on the Affordable Care Act, New Hampshire is feeling tremors from shifts occurring nationally, although the state’s health care landscape is more stable than the rest of the country. 

About a quarter of the nation, geographically, and around 17 percent, demographically, only have one insurer on the exchange, meaning less competition on rates, and therefore higher costs. Over the past year, UnitedHealthcare, Aetna and Humana have pulled out of the markets in most states, not getting the healthy populations they expected.

It's a good article, full of stats, figures, context and quotes. THere's even a nifty pie chart showing the relative market share of the carriers and so on.

Only one problem; can you spot it?

More last-minute carrier scrambling ahead of the OE4 kickoff...

Arise Health Plan, a subsidiary of WPS Health Solutions, said Thursday that it will not sell health plans on the marketplaces set up through the Affordable Care Act next year, becoming the latest company to abandon the market.

Arise and WPS Health Insurance also will sell only high-deductible health plans for individuals and their families off the marketplace, and those plans will be available only in a limited number of counties.

...For now, the marketplace for Milwaukee County next year will have four companies offering health plans: Molina Healthcare; Network Health Plan, owned by Ascension Wisconsin and Froedtert Health; Common Ground Healthcare Cooperative; and Children’s Community Health Plan.

Waukesha County tentatively will have those companies as well as Anthem Blue Cross and Blue Shield in Wisconsin and Dean Health Plan.

...Arise Health Plan has a relatively small share of the market in southeastern Wisconsin.

The Kaiser Family Foundation runs a monthly tracking survey, which I've referenced here many times before. Here's some key points from their September survey:

  • 77% of Americans say prescription drug costs are unreasonable in light of the Epi-Pen scandal, up from 72% a year ago
  • Approval/Disapproval of the ACA is split almost evenly, as usual (44% favorable, 47% unfavorable...which is actually better than I expected given all the bad news about rate hikes and carrier drop-outs in recent weeks)
  • The biggest healthcare-related concerns are (in order of decreasing importance): The future of the ACA in general; insurance premiums; insurance deductibles; drug prices; the uninsured; the opioid epidemic; and the Zika virus

There's a whole bunch of other interesting stuff, mostly about prescription drug issues, but there's one which made me feel like sticking my head in the oven (which wouldn't be very effective anyway, since ours is electric; I'd just end up burning my face):

THE NUMBER OF AMERICANS WITHOUT HEALTH INSURANCE

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