Charles Gaba's blog

Last Tuesday I noted that a package of bills designed to codify various ACA protections into state law here in Michigan (most of which are low-hanging fruit of my own healthcare wish list which I posted back in February) had managed to make it halfway through the legislative process: Five of them have passed the Michigan House, but not the Senate; the other three have passed the Michigan Senate...but not the House. I applauded the state legislature for pushing these bills halfway through and encouraged them to get the other half of the job done.

I was therefore highly amused and pleased to see MI Governor Gretchen Whitmer call for doing that the very next day in her "What's Next" address:

via the Connecticut Insurance Dept:

CONNECTICUT INSURANCE COMMISSIONER ANNOUNCES 2024 HEALTH INSURANCE RATES SAVING ACA HEALTH INSURANCE PLAN MEMBERS $96.2 MILLION AND HOLDING INSURER PROFITS TO 0.75%

(Hartford, CT) – In a significant move to protect Connecticut consumers against unsupported health insurance cost increases, Connecticut Insurance Commissioner Andrew N. Mais announced today that the Connecticut Insurance Department (CID) continues to protect consumers by reducing health insurers’ 2024 requested rates, despite ongoing increases in underlying health care costs. These 2024 rates are for individual and small group plans offered on and off the state exchange Access Health CT. The Connecticut Insurance Department does not regulate self-funded plans which fall under the authority of the U.S. Department of Labor.

Over at KFF (previously the Kaiser Family Foundation), researchers/analysts Jared Ortaliza, Krutika Amin & Cynthia Cox have put together a new analysis of the overall individual (aka non-group) U.S. health insurance market as of early 2023. While ACA exchange-based enrollment is publicly available (for both subsidized & unsubsidized enrollees) and is the primary focus of this website, off-exchange enrollment is always somewhat fuzzier for several reasons:

Over at Inside Health Policy, Amy Lotven has an excellent scoop from a new CMS report which was hiding in plain sight:

New CMS data, quietly released in late August, show about 178,000 consumers chose a qualified health plan (QHP) through a state or federal exchanges after losing Medicaid and CHIP coverage in the first two months of the Medicaid unwinding. Those sign-ups through the end of May are more than three times the 54,000 enrollments that CMS reported in July, which reflected only the April numbers.

A few weeks ago, I noted that Virginia's average 2023 unsubsidized ACA individual market premiums dropped by nearly 13% thanks to the newly-implemented state-based reinsurance program...but that they were at risk of skyrocketing by as much as 25% in 2024 due to that same reinsurance program being at risk of not continuing for a second year because of a budget standoff:

During 2021, the Virginia General Assembly passed HB 2332, the Commonwealth Health Reinsurance Program, which was signed into law on March 31, 2021 as Chapter 480, of the 2021 Virginia Acts of Assembly. This bill requires the State Corporation Commission to submit a waiver request for federal approval to establish a reinsurance program beginning January 1, 2023.

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:

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.