The American Academy of Actuaries has chimed in on the GOP Senate's #BCRAP Obamacare replacement bill, and I have to imagine that they had to bite their tongues clean through while composing this primer explaining the most rudimentary concepts behind "insurance", "risk pools" and "adverse selection" to Paul Ryan, Ted Cruz, Mike Lee and Mitch McConnell:
Risk Pooling: How Health Insurance in the Individual Market Works
Division of Insurance releases preliminary 2018 health insurance information
Final approval expected in late September / early October
DENVER (July 14, 2017) – The Colorado Division of Insurance, part of the Department of Regulatory Agencies (DORA), today released the preliminary information for proposed health plans and premiums for 2018 for individuals and small groups. From this point until August 4, Colorado consumers can comment on these plans.
All counties in Colorado
As the Division of Insurance noted in its June 21 news release, based on the plans filed, there is at least one insurance carrier planning to offer individual, on-exchange plans in every Colorado county. However, the insurance companies have indicated to the Division that they may be forced to reevaluate their participation in the marketplace if the lack of clarity at the federal level continues.
I've been writing for months now about the impact of the Trump/GOP Sabotage Effect on 2018 rate hikes. Generally speaking, premium increases will be due to four things:
Medical Inflation: That is, the actual increases in charges by hospitals, doctors, medical equipment, prescription medication, administrative overhead and so on. In a perfect world, this would be the only reason rates ever go up.
Reinstatement of the Health Insurance Providers Fee: One of the ACA's funding sources is a broad-based fee placed on health insurance companies themselves. Basically, a small portion of all premiums for all enrollees (including the total nongroup (on & off-exchange), small group and large group markets) is paid as a tax to the federal government which in turn uses it to partially fund the ACA's tax credits, CSR payments and Medicaid expansion provisions. The carrier tax was waived for 2016-2017, but is scheduled to be reinstated next year, so premiums wiill go up a bit accordingly. It's supposed to total around $14 billion next year.
Both of these are unfortunate, but make total sense in an ACA world: Healthcare costs do rise year to year (though at a slower pace since the ACA passed), while the carrier tax helps cover a chunk of the subsidies and Medicaid expansion funding.
Still cuts off tax credits at 350% FPL instead of the ACA's 400% FPL. Pass.
Still bases tax credits on a 58% AV Bronze plan instead of the ACA's 70% AV Silver plan. Pass.
Throws another $70 billion onto the "state stabilization fund" pile for a total of $132 billion
Throws another $70 billion on to "offset costs for high-risk patients" (I presume this means reinsurance?)
Yes, it includes the Cruz/Lee "Separate but Unequal" amendment; carriers could indeed go back to offering unregulated plans: No guaranteed issue, no community rating, no essential benefits, as long as they also offer a fully ACA-compliant plan
Tax credits couldn't be used for the unregulated plans, nor would they be attached to the risk adjustment program. In other words: Segregated risk pools
Catastrophic plans would be "counted" the same as other plans (ie, tax credits could be used for them), but they'd amount to the same as Bronze plans now anyway
It includes a #BakedAlaska giveaway to win over Lisa Murkowski...1% of funds have to go to "any state where premiums are 75% higher than average" (i.e., Alaska)
The database at the link above doesn't include the enrollee market share numbers; for that I had to dig up the actual filings at the SERFF database. Blue Cross Blue Shield and Presbyterian seem to be assuming no significant TrumpTax next year (which makes sense, since both will be off-exchange only, thus not subject to CSR payment concerns). Molina's filing is kind of odd--they seem to assume that CSR payments will be made...but that the individual mandate won't be enforced, which seems rather backwards to me (most TrumpTax filings assume neither will be enforced, or that the mandate will but CSR payments won't).
A small group of Democratic legislators will do something unusual Wednesday morning: hold a press conference to talk about the parts of Obamacare that are broken.
Ten House Democrats will unveil a new plan to fix Obamacare, highlighting the parts of the law that have struggled to work and offering modest steps to improve them. The proposal includes more funding to help insurance plans cover the sickest patients, along with possibly changing the timing of the open enrollment season in hopes of attracting more Americans to sign up for insurance.
These Democrats are agitating for a new strategy, one where they speak openly about the health law’s weak spots — particularly the individual market — and how to shore them up. The party has so far been reticent to highlight Obamacare’s problems at a moment when Democrats are fighting against Republican efforts to repeal parts of the law.
A shout-out to Jeremy Johnson for the heads up: The Montana Commissioner of Securities & Insurance has released their preliminary 2018 rate requests for the individual and small group markets...and it's pretty darned straightforward. As a nice bonus, they even saved me the trouble of digging up the effected enrollee numbers. In fact, the only critical data missing are the "Part II Justification" files, which hopefully clarify how the CSR payment/mandate enforcement situation plays into these requests.
Judging by the requests, it looks like at least 2 of the 3 on the individual market are assuming that CSR payments will continue and the mandate penalty will be enforced. As for the third (BCBSMT), they're asking for a 23.1% rate hike, so I honestly don't know whether that includes the TrumpTax or not. For the moment I'll assume it doesn't, but will change this later if I'm wrong about that.