Charles Gaba's blog


Earlier today, the U.S. Senate Committee on Homeland Security and Governmental Affairs (not sure why those two are lumped into a single committee, but whatever) held hearings on The State of Health Insurance Marketplaces.

Towards the end of the hearing (they were grilling several state insurance commissioners), Republican Senator Ron Johnson ended up quoting my "25-26% average rate hike" estimate for 2017, noting that this is significantly higher than the 12-13% average I (accurately) projected last year.

Needless to say, I have mixed feelings about this.

In my latest piece for, I list seven reasons why other states should follow the District of Columbia's lead by requiring that all individual market healthcare policies be sold on the ACA exchange exclusively...along with, I also admit, three issues which would have to be dealt with in doing so.

By an amazing coincidence (or perhaps not...some of the problems I think would be fixed/mitigated by doing this are very much in the news at the moment), GOP Senator Lamar! Alexander of Tennessee has come up with his own related idea...which approaches these problems from the exact opposite perspective:

Alexander Bill Would Extend Subsidies to Off-Exchange Plans

Sen. Lamar Alexander is introducing a bill Wednesday that would extend Affordable Care Act subsidies to plans off of the exchanges for some eligible consumers.

I don't usually post a whole lot about the small group market (other than occasionally trying to track how many SHOP enrollees there are by state and nationally), but this seems like pretty good news given how chaotic the individual market continues to be...

Covered California for Small Business Announces Rate Change and Expanded Coverage Choices for 2017

  • Statewide weighted average rate increase is less than 6 percent.
  • Blue Shield of California expands to Full PPO network statewide.
  • Kaiser Permanente moves into Santa Cruz County.

SACRAMENTO, Calif. — Covered California announced today the rates and expansion plans for its small group health insurance exchange, Covered California for Small Business. The statewide weighted average rate increase is 5.9 percent, for employers and their employees beginning Jan. 1, 2017, which is down from the 7.2 percent increase in 2016.

Between ConnectiCare in Connecticut, Centene in Arizona and now this, these last-minute changes are giving me ulcers trying to keep up...

Lindeen Finds Blue Cross Rate Increases Unreasonable

HELENA – Montana Commissioner of Securities and Insurance Monica Lindeen announced today that following an extensive rate review process, her office has found the rates filed for health insurance in the individual and small-group marketplaces by Health Care Services Corp. (doing business as Blue Cross Blue Shield of Montana) to be unreasonable. This is the first time that such a finding has been issued.

h/t to Bob Herman and Richard Mayhew for the tip:

OK, I admit that I first read this as Centene expanding into Pinal County (that's the one which came very close to not having any carriers on the exchange whatsoever, until Blue Cross Blue Shield agreed to stick around at the last minute). Unfortunately, no, Centene isn't going to offer plans there this fall. However, they are going to be participating on the ACA exchange in Maricopa and Pima Counties, which is still a very good development since Cigna and BCBS would otherwise have been the only exchange carriers in them respectively:

Centene Expands Marketplace Offering In Arizona

Over the past week or so there was a lot of tense negotiations and confusion about whether or not ConnectiCare, the 2nd largest carrier on Connecticut's exchange and the largest in CT's individual market overall, would bail on participating on AccessHealthCT next year. They bumped up their rate hike request not once but twice, from 14.3% to 17.4% to 27.1%, and when state regulators stuck with 17.4% and refused to budge any higher, they threatened to file a lawsuit and drop out of the exchange. As of last Friday, it looked like they were indeed pulling out.

I waited until yesterday (Tuesday) to post anything because I wanted to be sure about where things stood...but then, a few minutes later, it turned out that CTCare reversed itself at the last minute after all:

Days after declaring it would leave the state’s health insurance exchange, ConnectiCare has decided not to drop out of the marketplace, much to the relief of many — including Gov. Dannel P. Malloy.

Lots of stuff happening fast & furious these days as #OE4 approaches. Instead of individual posts, I'm gonna cram 7 state updates into a single one...and am also cheating a bit by cribbing off of excellent work by Louise Norris over at (which is fair, since she also gets some of her data from me as well):

ALABAMA: Here's what my requested rate hike table looked like for Alabama on August 1st:

Updates: Norris Confirms that:

As noted by Nicholas Bagley, Richard Mayhew and myself several times over the past year, Marco Rubio's Risk Corridor Massacre, which cut the ACA's risk corridor program off at the knees back in December 2014, has caused a tremendous amount of damage to the country in the form of helping kick 800,000 people off their healthcare policies, putting several hundred people out of work and could potentially cost taxpayers several billion dollars more than it would have cost if the program hadn't been interfered with in the first place...for no reason whatsoever. Rubio can't even argue that it was worth it for his own personal gain, since his stunt didn't even gain him the Republican Presidential nomination.

I have very few details on this one,

The great @katiedjennings reports NJ is ordering Health Republic of NJ to cease plan offerings in 2017. cc: @khemp64 @pauldemko

— Dan Goldberg (@DanCGoldberg) September 12, 2016

@charles_gaba @DanCGoldberg @khemp64 @pauldemko they lost $59M in first 6 months of the year

— Katie Jennings (@katiedjennings) September 13, 2016

Her story is buried behind a firewall at POLITICO Pro, but I do have some crucial info:

I know, the headline is clickbait, but hear me out; lemme play Devil's Advocate for a moment here.

Last week, when writing about Phoenix Health Plans becoming the latest carrier to drop out of the Arizona exchange, I noted that...

Ironically, this may prove to have a silver lining, according to one expert:

If Cigna decides to stick with the exchange marketplace, it will have access to a solid mix of healthy and unhealthy patients, said Jim Hammond, publisher of the Hertel Report.

"The first question is, will Cigna stay in," Hammond said. "If Cigna bails, then we have a real problem and the state and federal officials are going to have to figure out what to do about it. They've made this mandate and there's no way for people to actually meet the mandate."

Once an insurance carrier gets a decent mix of healthy and unhealthy patients, and targets the unhealthy patients with special programs, then it should be fine, he said.

I didn't really make a big thing out of it, but thought it was an interesting perspective.