Charles Gaba's blog

Massachusetts, which is arguably the original birthplace of the ACA depending on your point of view (the general "3-legged stool" structure originated here, but the ACA itself also has a lot of other provisions which are quite different), has 10 different carriers participating in the individual market.

One thing which sets Massachusetts (along with Vermont) apart from every other state is that their Individual and Small Group risk pools are merged for premium setting purposes.

Normally you would think this would make my job easier, since I only have to run one set of analysis instead of two...but until recently, it was surprisingly difficult to get ahold of exact enrollment data for each carrier on the merged Massachusetts market (and even more difficult to break out how many are enrolled in each market since they're merged...not that that's relevant to the actual rate changes).

via the Centers for Medicare & Medicaid Services (CMS):

Model aims to improve the overall health of a state population by ensuring providers are delivering efficient, high-quality, and coordinated care to patients

Today, the Centers for Medicare & Medicaid Services (CMS) unveiled a transformative step to test a state’s ability to improve the overall health care management of its state population. The States Advancing All-Payer Health Equity Approaches and Development Model (“States Advancing AHEAD” or “AHEAD Model”) aims to better address chronic disease, behavioral health, and other medical conditions. Under the AHEAD Model, participating states will be better equipped to promote health equity, increase access to primary care services, set health care expenditures on a more sustainable trajectory, and lower health care costs for patients.

Last spring I wrote up a deep dive into New Mexico's proposed Medicaid-based Public Option (called "Medicaid Forward"):

Medicaid Forward would allow residents whose incomes are too high to qualify for Medicaid to instead purchase an affordable plan through the program. Medicaid is a robust, comprehensive program that already provides high-quality care to nearly 50% of our residents. Expanding this simple and trusted system will make healthcare less expensive for people of all backgrounds.

...Medicaid Forward is a good deal for New Mexico. New Mexico can raise its current Medicaid income limit and the federal government will still match nearly 73% of the costs. For the remaining costs, participants will pay for coverage on a sliding scale based on their income.

...Medicaid Forward would open Medicaid so every resident has access to affordable care. We envision a New Mexico where every person, regardless of their background or income, has the opportunity to live their healthiest life.

As I noted at the time:

BeWell NM

via BeWell NM, New Mexico's state-based ACA exchange:

The annual report, as mandated by the 2021 New Mexico Statutes Chapter 59A, Article 23F, Section 59A-23F-10, and compiled jointly by beWellnm, New Mexico’s Health Insurance Exchange, and the New Mexico Office of the Superintendent of Insurance (NM OSI), offers a comprehensive analysis of various key aspects. These include the individual health insurance market, both on- and off-Exchange enrollment, small business enrollment, qualified health plan pricing, outreach and enrollment assistance activities, as well as strategies aimed at addressing the challenge of the remaining uninsured population in New Mexico.

Overview of the Individual Health Insurance Market

(original post: 5/22/23)

Via the Oregon Dept. of Consumer & Business Services (Division of Financial Regulation):

Salem – Oregon consumers can get a first look at requested rates for 2024 individual and small group health insurance plans, the Oregon Department of Consumer and Business Services (DCBS) announced today.

In the individual market, six companies submitted rate change requests ranging from an average 3.5 percent to 8.5 percent increase, for a weighted average increase of 6.2 percent. That average increase is slightly lower than last year's requested weighted average increase of 6.7 percent.

In the small group market, eight companies submitted rate change requests ranging from an average 0.8 percent to 12.4 percent increase, for a weighted average increase of 8.1 percent, which is higher than last year's requested 6.9 percent average increase.

Every month for years now, the Centers for Medicare & Medicare Services (CMS) has published a monthly press release with a breakout of total Medicare, Medicaid & CHIP enrollment; the most recent one was posted in late February, and ran through November 2022.

Since December 2022, however, they haven't sent out the normal press release; instead, they included a brief note leading to a Medicaid/CHIP data slideshow , along with another note leading to their new Medicare Monthly Enrollment database.

In any event, according to the spreadsheet I exported, as of May 2023:

Earlier today I noted that according to the most recent Medicare enrollment report from the Centers for Medicare & Medicaid Services (CMS), Medicare Advantage enrollment--in which a private insurance carrier is paid by the federal government to administer Medicare benefits, and which differs in some important ways from "traditional" or "Fee for Service" Medicare--is on the verge of overtaking traditional Medicare in terms of total enrollment.

As of May 2023, 48.5% of all Medicare enrollees were covered via a Medicare Advantage plan, a percentage which has been steadily increasing over the years (it was only at 35.5% as of 2019).

While I mention this every time I post about the latest Medicare enrollment report, it's been some time since I've checked on the traditional vs. privately administered variants of Medicaid enrollees. For a long time I've been under the impression that roughly 70% of Medicaid enrollment was handled via Managed Care Organizations (MCOs):

via the Centers for Medicare & Medicaid Services (CMS):

In May 2023, 93,815,749 individuals were enrolled in Medicaid and CHIP.

  • 86,783,676 individuals were enrolled in Medicaid in May 2023, a decrease of 279,373 individuals (-0.3%) from April 2023.
  • 7,032,073 individuals were enrolled in CHIP in May 2023, a decrease of 41,687 individuals (0.6%) from April 2023
  • As of May 2023, enrollment in Medicaid and CHIP has decreased by 61,085 since March 2023, the final month of the Medicaid continuous enrollment condition under the Families First Coronavirus Response Act (FFCRA) and amended by the Consolidated Appropriations Act, 2023.
    • Medicaid enrollment has increased by 69,102 individuals (0.1%).
    • CHIP enrollment has decreased by 130,187 individuals (1.8%)
  • Between February 2020 and March 2023, enrollment in Medicaid and CHIP increased by 23,001,765 individuals (32.5%) to 93,876,834.
    • Medicaid enrollment increased by 22,634,781 individuals (35.3%).
    • CHIP enrollment increased by 366,984 individuals (5.4%)

via the Centers for Medicare & Medicaid Services:

Builds on President Biden’s Historic Commitment to Create a Long-Term Care System Where People Can Live with Dignity 

Today, the U.S. Department of Health and Human Services (HHS), through the Centers for Medicare & Medicaid Services (CMS), issued a proposed rule that seeks to establish comprehensive staffing requirements for nursing homes—including, for the first time, national minimum nurse staffing standards—to ensure access to safe, high-quality care for the over 1.2 million residents living in nursing homes each day. This proposed rule builds on the President’s historic Action Plan for Nursing Home Reform launched in the 2022 State of the Union.


via Access Health CT:

These free, in-person events will take place in Litchfield, New Britain, Vernon and Willimantic

HARTFORD, Conn. (Aug. 30, 2023) — Access Health CT (AHCT) can help eligible Connecticut residents enroll in HUSKY Health, the state’s Medicaid program, and Qualified Health Plans. To help residents understand the types of health coverage available to them, AHCT will host free, in-person enrollment fairs in September and October. Many HUSKY Health clients have been affected by “Medicaid Unwinding,” a term the federal government is using to describe the process of resuming reviewing households for Medicaid eligibility after a three-year break during the Public Health Emergency. The eligibility redetermination process resumed April 1 and HUSKY clients will be notified when it is their turn to enroll.