I just realized that while I've written quite a bit about the potential loss of Medicaid coverage for thousands of residents of Michigan, Kentucky and Arkansas over the past few months due to the new work requirement laws in those states, It's been far too long since I've given a shout-out to the four states which are hoping to add Medicaid expansion (or at least continue it, in one case) exactly one week from today.
For years, elected leaders in conservative states have resisted expanding Medicaid, the government health program for low-income Americans. Now voters in four of those states will decide the question directly.
Last year there was an unprecedented amount of uncertainty and chaos surrounding the Affordable Care Act. On the one hand, you had Congressional Republicans desperately attempting to repeal the ACA altogether a good half a dozen times...and coming within a single "thumbs down" of doing so at one point.
At the same time, you had Donald Trump screaming into the wind about doing everything he could to simultaneously cause the ACA exchanges to "blow up" or "implode", depending on the tweet of the day, culminating in him finally pulling the plug on Cost Sharing Reduction reimbursement payments.
There was practically no change whatsoever between the rate changes requested by Louisiana carriers for the 2019 ACA individual market and the rates approved by the state insurance regulators. However, it's still good to be able to lock in the official rates just ahead of the Open Enrollment Period itself, including the individual filing data.
Overall, unsubsidized premiums should drop around 6.5%, which is good news...except that, once again, if it weren't for the ACA's individual mandate being repealed and #ShortAssPlans being expanded by the Trump Administration, I estimate they'd be dropping by another 9.3%, give or take, for a total premium reduction of more like 15.8% on average.
At $649/month full-price on average this year, that means the average unsubsidized enrollee will be paying somewhere around $724 more apiece next year due to those factors.
OK, this is a pretty minor update, but in the interest of completeness I should post it.
In mid-September, the Washington State insurance commissioner posted the approved 2019 average ACA individual market premium changes for carriers statewide, coming in at 13.8% overall.
The only problem is that the report only included the seven on-exchange ACA market carriers. The four carriers which offer off-exchange policies (which are pretty much identical and are part of the same risk pool, but don't qualify for tax credits) weren't included. They make up roughly 23% of Washington State's total individual market.
Today, just a few days before Open Enrollment begins, the WA Insurance Commissioner posted the complete approved rate change information. The overall average has dropped slightly, to 13.6%:
Eleven insurers approved to sell 74 plans in Washington's 2019 individual market
13.57 percent average rate increase approved
It isn't often that I write about anything Oklahoma-related, and it's rarer still that I post good news out of the...um..."labor omnia vincit" state (that's their slogan, I looked it up...), so today's a rare day indeed.
Here's what he's talking about: The massive searchable/filterable database which CMS maintains every year which includes pretty much every conceivable detail about every ACA-compliant health insurance policy available from every carrier in every region of all 39 states whose ACA exchanges are hosted on HealthCare.Gov (it doesn't include the 12 states which operate their own ACA exchanges, unfortunately).
As regular readers know, every spring/summer I spend countless hours poring over the annual insurance carrier rate filings, plugging in increases (and occasionally decreases) in ACA-compliant premium changes for every carrier in every state. I actually do this twice for most states (and occasionally even three times), as the process moves from preliminary/requested rate changes to "semifinal" rates to "final/approved" rates throughout the fall.
For 2018 and again for 2019, I've taken this one step further; instead of simply running the overall weighted average premium changes in each state, I've also attempted to break out what portion of the change is caused by various factors...in particular, what portion is caused by legislative or regulatory changes by Congressional Republicans and/or the Trump Administration.
There's so many Republican candidates running around trying to gaslight America into completely ignoring their relentless, repeated attempts to strip away protections for people with pre-existing conditions that I've alread stopped bothering to try to keep up with them (I think my Rogues Gallery post stops at around 24 or so at the moment).
Here in Michigan, while I'm pretty sure all nine of our Republican members of Congress who voted for the AHCA last year are lying through their teeth about how they suddenly support "protecting coverage of pre-existing conditions", the one which seems to be getting the most attention is Mike Bishop (MI-08). Part of this is no doubt because Bishop is embroiled in one of the two closest races in the state (the other is MI-11, where Dave Trott also voted for the AHCA, but he's retiring so it's an open seat).
One of the great strengths and dangers of the ACA is that it includes tools for individual states to modify the law to some degree by improving how it works at the local level. The main way this can be done is something called a "Section 1332 State Innovation Waiver":
Section 1332 of the Affordable Care Act (ACA) permits a state to apply for a State Innovation Waiver to pursue innovative strategies for providing their residents with access to high quality, affordable health insurance while retaining the basic protections of the ACA.
State Innovation Waivers allow states to implement innovative ways to provide access to quality health care that is at least as comprehensive and affordable as would be provided absent the waiver, provides coverage to a comparable number of residents of the state as would be provided coverage absent a waiver, and does not increase the federal deficit.
