Charles Gaba's blog

Originally posted 8/10/23; updated 11/07/23

Nebraska doesn't even bother listing indy/small group plan rate filings on their own insurance department website...the link goes directly to the federal Rate Review database. The problem with this is that very few filings here are unredacted, which means it's difficult to acquire the policy enrollees for many carriers needed to run a weighted average.

Nebraska has 4 carriers on the individual market for 2024: BCBS, Medica, NE Total Care and Oscar Health. The unweighted average rate increase being requested is around 2.9%.

I also don't have the enrollment for any of the 4 Small Group market carriers. It also looks like Aetna is pulling out of the NE sm. group market, but it might just be that the federal database doesn't have them listed yet  The unweighted average rate change being requested there is a 7.9% increase.

UPDATE 11/07/23: No changes were made to the preliminary rate filings for the individual market; for the small group market, Blue Cross Blue Shield had their requested increase shaved down by about 1.7 points.

Originally posted 8/14/23; updated 11/07/23

This one is particularly frustrating. In addition to the filings being listed at the federal Rate Review website, every individual & small group market carrier also has their filings listed via the SERFF database and via New Mexico's own internal, searchable rate filing database...and yet I still can't run a weighted average rate change for either market because almost none of the filings at any of these three databases includes the actual enrollment data (Presbyterian on the individual market is the exception).

As a result, I have to once again settle for unweighted averages, which come to +5.6% on the individual market and +7.7% for small group plans.

UPDATED 11/07/23: In the end there were only slight tweaks made to a few carrier requests in either market.

Last week I reported that at least 593,000 of the "Medicaid Unwinding" population (Americans who had their Medicaid or CHIP coverage terminated since the end of the COVID public health emergency's "Continuous Coverage" provision ended at the end of March) had shifted over to an ACA exchange plan as of the end of July (plus another 88K who enrolled in BHP plans).

As I noted at the time, perhaps 11% or so of the Unwinding population might move to ACA exchange policies instead when the dust settles on the ongoing unwinding process (12% or so if you include BHP enrollees).

Today, Amy Lotven of Inside Health Policy reports some additional data which indirectly supports this:

Originally posted 8/09/23; updated 11/07/23

Louisiana's rate filing database is frustrating, because it's both highly-detailed and confusing at the same time.

They break out the filings not between Individual and small group markets or on- vs. off-exchange policies, but between rate increases over and under 10%. Normally that would be fine, but they also have multiple listings within each market for several carriers; HMO Louisiana, in fact, has 11 entries, each for a different product line, making it tedious and difficult to piece together the weighted average rate change and current enrollment for the carrier as a whole.

Not that any of that matters this year, as they don't appear to have posted any of the ACA-compliant individual market filings there anyway. I had to rely entirely on the federal Rate Review site, and the filings there still don't include enrollment data for most carriers, so the averages below are all unweighted only:

  • Individual Market: Around 1.7% higher
  • Small Group Market: 9.4% higher

It's worth noting, however that Humana is, once again, dropping out of the states' small group market, while Vantage Health Plan appears to be pulling out of both the individual and small group markets in Louisiana.

UPDATE 11/07/23: In the end, every requested rate change was approved as is in both markets.

Originally posted 8/16/23; updated 11/07/23

Unfortunately, South Carolina is another state where they don't make unredacted rate filings available, either on the state insurance dept website, the federal Rate Review website or the SERFF database.

As a result, I'm limited to unweighted averages for both the individual and small group markets:

  • Individual Market: +3.7%
  • Small Group Market: +8.9%

UPDATED 11/07/23: A couple of interesting modifications were made in the individual market by state regulators: Blue Cross Blue Shield had their rate hikes cut from 6% to 2.7%; BlueCHoice was cut from 2.1% to essentially flat; Cigna will see a 17.8% average increase instead of their requested 10.5% hike; Molina drops from +6.4% to +4.6%; and Select Health, which had planned on reducing premiums by 4.6 points will instead see an average 1.3% increase. Huh.

Originally posted 8/10/23; updated 11/07/23

The good news about the Montana Insurance Dept. is that once the final, approved annual rate changes for the individual and small group markets are released, they're pretty good about posting them in a clear, transparent manner.

The bad news is that they only do so for the final rates, not the preliminary/requested rate filings.

For that, I have to yet again rely on an unweighted average of the rate filings from the federal Rate Review website.

Montana only has three carriers on the indy market and four on the small group market. Of these, Montana Health Co-Op is providing their actual enrollment numbers for both, although one is in a roundabout way. For their individual market filing they state that:

Originally posted 8/10/23; updated 11/07/23

Unfortunately, Mississippi is another state which provides zero useful rate filing data for my purposes (preliminary or final) prior to the Open Enrollment Period launching. The only data I have is from the federal Rate Review website, and even the filing forms there are heavily redacted, so all I can put together are unweighted averages for the 2024 calendar year.

It's worth noting that one of the three UnitedHealthcare divisions appears to be dropping out of Mississippi's small group market, as is Humana (which seems to be pulling out of a lot of small group markets nationally).

With that in mind, unsubsidized individual market enrollees are looking for unweighted average increases of around 2.3%, while small group carriers are hoping to increase rates by around 4.5% (again, unweighted).

UPDATE 11/07/23: In the end, there were virtually no changes made to the final/approved rate changes for either market.

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

In July 2023, 91,521,722 individuals were enrolled in Medicaid and CHIP.

  • In July 2023, 91,521,722 individuals were enrolled in Medicaid and CHIP.
    • 84,504,888 individuals were enrolled in Medicaid in July 2023, a decrease of 1,106,693 individuals (1.3%) from June 2023.
    • 7,016,834 individuals were enrolled in CHIP in July 2023, an increase of 17,565 individuals (0.3%) from June 2023.
  • As of July 2023, enrollment in Medicaid and CHIP has decreased by 2,396,487 individuals 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 decreased by 2,284,727 individuals (2.6%).
    • CHIP enrollment has decreased by 111,760 individuals (1.6%).
  • Between February 2020 and March 2023, enrollment in Medicaid and CHIP increased by 23,043,140 individuals (32.5%) to 93,918,209.
    • Medicaid enrollment increased by 22,709,822 individuals (35.4%).
    • CHIP enrollment increased by 333,318 individuals (4.9%).

Back in April, the Associated Press reported that the Biden Administration planned on opening up eligibility for ACA exchange, Basic Health Program, Medicaid & CHIP coverage to hundreds of thousands of Americans who have Deferred Action of Childhood Arrivals status:

President Joe Biden is set to announce that his administration is expanding eligibility for Medicaid and the Affordable Care Act’s health insurance exchanges to hundreds of thousands of immigrants brought to the U.S. illegally as children, according to two U.S. officials briefed on the matter.

The action will allow participants in the Obama-era Deferred Action for Childhood Arrivals program, or DACA, to access government-funded health insurance programs. The officials spoke on the condition of anonymity to discuss the matter before the formal announcement on Thursday.

As I noted at the time:

As long-time readers know, every year during the ACA Open Enrollment Period (OEP) I have a tradition of regularly updating a graph tracking how many Americans have enrolled in on-exchange Qualified Health Plan (QHP) policies nationally. The Graph®, as I've come to call it, is how this entire website got started; the logo for ACA Signups even consists of a stylized version of the original version from the 2013 - 2014 OEP.

That first year I attempted to track every conceivable population--on-exchange QHPs, off-exchange QHPs, Medicaid expansion enrollment, SHOP (ACA small business exchange) enrollees) and even the amorphous "sub-26er" populations of young adults enrolled in their parents employer plans thanks to ACA provisions. Some of these were nearly impossible to accurately estimate, but I really tried my best.

Over the next year or two, I not only dropped the categories which I wasn't able to track properly, my tracking of the remaining ones became much more streamlined and sophisticated. Eventually I decided to stick with just two categories: On-exchange QHPs and those enrolled in the Basic Health Plan (BHP) programs in Minnesota and New York.