Charles Gaba's blog

Maryland was one of the first states I ran a weighted average rate request on back in May. At the time, it looked like around a 15.0% average request for the individual market state-wide:

However, as with Arizona and Tennessee, the largest carrier in the state has since submitted revised rate requests:

BALTIMORE – Commissioner Al Redmer, Jr. will be conducting a second public hearing on Monday, August 15th from 11 am – 1 pm at the Maryland Insurance Administration located at 200 St. Paul Place, 24th floor Hearing Room, Baltimore, MD 21202 to receive public input on a revised filing made by CareFirst. On July 26, CareFirst refiled its 2017 proposed rates for the individual market and requested a 27.8% rate increase for HMO plans and a 36.6% rate increase for PPO plans. CareFirst previously requested a 12.0% and 15.3% rate increase, respectively.

I noted back in February that Vermont Health Connect, VT's ACA exchange, has remained essentially silent since last fall, issuing only 2 press releases since Open Enrollment started last November (one of which was about a new plan comparison tool, the other of which was about some sort of Medicaid-related dealine). In other words, they haven't publicized their 2016 enrollment numbers whatsoever...the only reason I have data for VT at all is thanks to the official ASPE reports from the HHS Dept. This is a stunning 180º turnaround from 2015, when they were issuing detailed reports on a regular basis.

I noted a few days ago that the Tennessee Dept. of Insurance is allowing 2 major carriers, Cigna and Humana, to re-submit filings for the 2017 individual market.

I noted at the time,

Cigna and Humana would have to revise their requests up to 50% apiece in order for the statewide average to end up hitting the 60% threshold, but that's not exactly a vote of confidence when it's already in the 56% range to begin with.

Well, neither one quite hit the 50% mark, but they both came close:

In its latest filing, Cigna is proposing an average 46 percent increase — double its first 23 percent increase request.

Humana, which requested a 29 percent average increase in June, is requesting an average 44.3 percent increase, according to a filing with the state regulators.

Here's what that looks like on the weighted average table:

Rhode Island, in addition to being one of the smallest states, is also one of the first states I crunched the rate hike numbers for back in late May. It was actually pretty easy to run a weighted average hike request since there are only 2 carriers even operating on the individual market next year: Blue Cross Blue Shield of RI and Neighborhood Health Plan (UnitedHealthcare is dropping out of the RI indy market entirely, but only has about 1,400 people enrolled to begin with).

Anyway, BCBS was asking for a 9% increase, while Neighborhood is among the very few carriers to actually request a rate decrease...of around 5%. As a result, Rhode Island has the honor of having the lowest average rate hike request of all 50 states (+DC) next year...a mere 3.6% overall, which is awesome.

Well, nearly 3 months later, the RI Insurance Commissioner has weighed in with even more good news: Rates will be going up even less than that in 2017:

Thanks to Dan Goldberg for the heads up:

NY State of Health: The Official Health Plan Marketplace 2016 Open Enrollment Report August 2016

It's a whopping 64 pages long. Some of it is stuff like "how many people speaking Cambodian called the support lines?" (answer: 6) and the like, but there's also a whole bunch of handy data regarding actual healthcare policy/program enrollment in the Empire State. I don't mean to be ungrateful, as this is extremely comprehensive...but it would've been far more useful if the report had included data from the end of March (or even later), as opposed to cutting off at the end of the 2016 Open Enrollment period (January 31st). Due to attrition due to people who never pay their first premium, are denied policies for legal reasons (residency status, etc) and so on, only around 82% of the 272,000 people who selected QHPs in NY during OE3 were still actually enrolled as of two months later. A good 10-12% or so never paid in the first place and another 6-8% were kicked off involuntarily for one reason or another...none of which is reflected in this report.

Still, that aside, let's take a look!

According to the official HHS Dept. ASPE Report, 55,183 New Hampshire residents "selected a Qualified Health Plan" from the ACA exchange during the 2016 Open Enrollment Period.

Of course, as I (and others on both sides of the political spectrum) have written about many, many times, not everyone who selects a QHP (either on or off the exchanges) actually pays their first premium, and therefore is never actually enrolled in an active, effectuated policy. This amounted to roughly 12-13% of all QHP selections in 2014, but got a bit better over the next two years as people got used to how the system works and technical improvements were made. In addition, another chunk of QHP selections were scrapped by the HHS Dept. or state exchanges at later points thorughout 2014 for a variety of reasons ranging from legal residency issues to other data matching problems. Again, this percentage has been gradually whittled down as improvements to the system have been made.

With all the concern about the ACA exchange risk pool being sicker than expected as well as plenty of grumbling about how the ACA's Risk Adjustment program is working out in practice, earlier today Kevin Counihan, the CEO of the Health Insurance Marketplace (i.e., the guy in charge of HealthCare.Gov) posted a blog entry laying out some changes that CMS has in mind for the RA program going forward. It's interesting stuff for health insurance wonks, but to be honest, I was more interested in a different document also released today (referenced in the RA blog):

Changes in ACA Individual Market Costs from 2014-2015: Near-Zero Growth Suggests an Improving Risk Pool

(as whoever posted the commercial to YouTube noted, "Seriously, who struts down the sidewalk munching on a jar of peanut butter?")

I've written quite a few times before about how the small group insurance market is sort of the odd man out when it comes to the Affordable Care Act. The SHOP exchanges have turned out to be mostly a dud (to the point that the HHS Dept. has only stated once just how many people are even enrolled in SHOP policies (and even that was missing some states; my best guesstimate is arouns 150,000 nationally).

There was, in the early days of the ACA, some controversy over just how large a "small business" could be defined as--the law bumped it up from 50 employees to 100, though this provision was later repealed, keeping 50 as the cut-off point.

A quickie: Just 5 days ago it was reported that...

As of the beginning of August, 265,723 low-income Louisianians have newly signed up for Medicaid, according to state officials.

Well, according to NOLA reporter Kevin Litten just now...

INBOX: Medicaid expansion in Louisiana topped 278,000 people on Wednesday. That leaves about 100k people to sign up to hit goal by 2017.

— Kevin Litten (@kevinlitten) August 10, 2016

That's a net increase of 12,277 people in just 9 days, or over 1,300 per day.

There are an estimated 375,000 Louisianans eligible for ACA Medicaid expansion. If they can enroll another 700/day, they'll have maxed out by New Year's Eve.

Over a year ago, I posted a piece over at healthinsurance.org which listed 4 questions which you should ask before freaking out over a scary-sounding "MASSIVE RATE HIKE!!" headline.

The third point was this one:

3. Consider actual dollar amounts

What are the actual old and new dollar amounts that we’re talking about here?

Remember, until now we’ve been talking purely about percentages … but that can be very misleading. In our hypothetical example, Acme is a new player on the market. They priced aggressively last year in order to steal customers away from the more familiar brand names, and managed to get 5 percent of the market; not bad.

Unfortunately, those customers turned out to be loss leaders – it’s costing them more to care for their enrollees than they’re being paid, so they jacked up their rates 25 percent this year, while Blue Cross is only raising theirs 6 percent (weighted).

HOWEVER, when you look at the average premium dollar amounts of each company, look what happens: