Charles Gaba's blog

Thanks to Thiago Santiro in the comments for this heads up:

Blue Cross Blue Shield of Texas will be the sole player in the ACA marketplace here, making Tarrant County the largest metro area in the state down to one participant.

Four of the previous insurers in the county — Aetna, Scott & White, Cigna and UnitedHealth — each confirmed they have pulled out of the ACA marketplace throughout the state.

According to my original estimates from back in May, Cigna only has around 19,000 people enrolled in individual market plans to begin with: 14,000 via Cigna Health & Life Insurance, 5,000 via Cigna Healthcare of Texas. However...

...Cigna also will continue to offer individual plans off the marketplace, according to spokesman Joe Mondy.

A week or so ago, the Washington Insurance Commissioner announced that the weighted average rate hike for 46 plans certified by the state insurance dept. regulators is 13.1%. However, there was a major caveat: There were another 52 plans which still had to be certified by the board. Without knowing the average rate hike for the other half of the plans, there's no way of knowing what the final approved average increase will be.

In addition, I also don't know what the relative market share of any of the plans (certified vs. uncertified) is, so there's no way of weighting the average across the full market. For all I know, 90% of enrollees might be among the first 46 (in which case any variances mong the other 52 plans would barely move the needle). Alternately, 90% could be among the missing 52 plans, or anywhere in between.

WIth that in mind, here's a press release from the WA exchange yesterday:

Yesterday I reported that after the big scare about Pinal County, Arizona possibly having no carriers on the exchange, and the rest of the state only having one available, things were looking up as 1) Blue Cross Blue Shield agreed to jump back into Pinal after all, followed by 2) Centene also expanding coverage into a couple of counties, meaning 2 carriers for most of the population.

Unfortunately, as M E notes in the comments:

This isn't really the good news you were hoping for. With Centene in, Cigna is out.

Maricopa County residents could have a new health insurer on the Affordable Care Act exchange next year, but it might not be the insurer that many local observers thought it would be.

Last month I noted (well, after Louise Norris called my attention to it) that after 2 years of restricting all individual market enrollments to their still-buggy ACA exchange, the state of Vermont actually reversed this policy for 2016 by allowing individuals to enroll in ACA-compliant policies directly through the carriers after all.

This actually goes against the recommendations I just wrote about yesterday, leaving the District of Columbia as the only other exchange to require all indy plans to run through it), but given how many technical problems Vermont seems to still be having with their platform, I can understand them allowing direct enrollment for the time being. I stand by my recommendation that every state should eventually move everything onto the exchange in the future, however.

As I've been noting for a few months now, Connect for Health Colorado's monthly enrollment reports are chock full of data and confusing as hell at the same time.

As a result, I've started simply presenting them without much commentary. Here's the August report:


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