As of 2014, key provisions of the Patient Protection and Affordable Care Act (PPACA) resulted in the establishment of health insurance exchanges in each state and changed how insurers determined health insurance premiums. Individual market consumers generally had access to more health plans in 2015 compared to 2014, and in both years the lowest-cost plans were available through exchanges in most of the 1,886 counties GAO analyzed in the 28 states for which it had sufficiently reliable data for plans offered either on or off an exchange. In addition, consumers in most of the counties analyzed had six or more plans to choose from in three of the four health plan metal tiers (bronze, silver, and gold) in both 2014 and 2015, and the percentage of counties with six or more plans in those metal tiers increased from 2014 to 2015. Consumers had fewer options regarding platinum plans, although the availability of platinum plans generally also increased from 2014 to 2015. The lowest-cost plan available in a county was available on an exchange in most counties. For example, among the 1,886 counties analyzed, GAO found that the lowest-cost silver plan for a 30-year-old was available on an exchange in 63 percent of these counties in 2014 and in 81 percent of these counties in 2015—an increase of 18 percentage points.
Yesterday I noted that the "sequel" (in spirit, not in actuality) to the King v. Burwell federal case, House v. Burwell, has been given the green light to proceed by a federal judge...or at least the part of the lawsuit most relevant to this site and most everyday people:
A federal judge ruled on Wednesday that House Speaker John Boehner's lawsuit over the implementation of Obamacare can move forward, setting the stage for another high-stakes legal battle over President Obama's signature legislative accomplishment.
The suit, brought by Speaker of the House John Boehner and the House Republicans, has two major components: Attacking the Obama administration for delaying implementation of the Employer Mandate portion of the ACA by a year (which was done because most businesses needed more time to prepare for this provision, and which is doubly stupid because the GOP has voted to repeal the entire law dozens of times anyway); and attacking the administration for implementing the Cost Sharing Reduction provision, which they claim the administration wasn't specifically authorized to do.
I posted about this back on July 3rd, just a week after the historic King v. Burwell Supreme Court ruling, which put the Constitutional seal of approval on the ACA's Advance Premium Tax Credits (otherwise known as the Federal Tax Subsidies) for over 6 million people across the 3 dozen Healthcare.Gov states.
The short version is that there's Yet Another lawsuit winding its way through the federal court system: House vs. Burwell. This is the one which is being brought by John Boehner and the House Republicans against the Obama administration. Here's the recap.
As I understand it, there's 3 main issues at hand:
9 of the 20 states which saw an increase in effectuated enrollees from 3/31 to 6/30 are state-based exchanges (remember, there's only 14 of these).
26 of the 30 states (+DC) which saw a decrease in enrollees are Healthcare.Gov states (mainly due to the 306,000 enrollees terminated due to legal residency issues).
The highest off-season increase: Massachusetts, which saw a 20.7% increase in enrollees mainly due to their policy allowing year-round enrollment in "ConnectorCare" QHP policies.
The worst off-season decrease: Mississippi, which lost 9.3% of their effectuated enrollees during the quarter.
Colorado's June number is listed as being identical to their March number because CMS was unable to verify their June enrollment and simply copied the March number over. Their unofficialJune 30 figure is 134,200, or about 9.1% higher than it was on 3/31.
The percent of enrollees with APTC (Advanced Premium Tax Credits) has dropped slightly, from 85% in March to 83.7% in June.
The percent of enrollees with CSR (Cost Saving Reduction) has also dropped a bit, from 57.4% to 56%
Both of these suggest that the bulk of those who have been kicked off for proof-of-legal-residency issues tend to be lower-income, which makes sense. Update: Andrew Sprung notes that some people may have lost their tax credits or CSR assistance without losing their policies if they reported an income change or if their original income claims can't be verified, so perhaps not).
The average federal tax credit amount has also gone down very slightly ($272/month to $270).
The Metal Level ratio, however, hasn't shifted at all; it remains 1% Catastrophic, 21% Bronze, 68% Silver, 7% Gold and 3% Platinum.
For months now, I've been operating on the assumption that the total number of currently effectuated private ACA exchange policies has been roughly 10.3 - 10.4 million, give or take. This was based on a combination of last year's enrollment pattern, the 214,000 additional people who selected QHPs during the #ACATaxTime special enrollment period, as well as assorted state-level enrollment updates out of California, Maryland and a few other state-based marketplaces.
Last year, GOP Governor Tom Corbett pushed through a poorly-conceived, overly-cumbersome "Republican alternative" Medicaid expansion program called Healthy PA, which didn't go into effect until late in the year. He was defeated by Democrat Tom Wolf, who vowed to scrap the "alternative" version and simply expand Medicaid to residents below 138% of the Federal Poverty Level, as the ACA had intended.
Department of Human Services Sec. Ted Dallas Tuesday announced the end of the transition from Healthy PA to traditional Medicaid expansion—known as HealthChoices in Pennsylvania—as the last of the expansion insurance plans took effect.
According to Sec. Dallas, 440,000 Pennsylvanians are enrolled in Medicaid expansion insurance plans with the last group of enrollees coming out of Healthy PA’s primary coverage options into Medicaid expansion.
“With that last group of folks moving over, the Medicaid expansion is now complete,” Sec. Dallas told reporters.
The obligatory update. Assuming around 8,000 off-season QHP selections per day nationally (which was recently confirmed by CMS...even higher than the 7,500/day I had previously been estimating), the grand total should be crossing the 13.5 million mark sometime this holiday weekend if it hasn't already.
This won't likely have any impact on the currently effectuated number of course, which is likely still hovering around the 10.4 million mark, but it's still an important symbolic milestone to achieve.
Montana's Dept. of Insurance website doesn't really provide the actual rate filings (or if it does, I can't find them), but it does include this handy chart laying out every carrier offering individual policies in the state (there's only four of them, and one, Assurant, just went belly-up this past spring). That leaves just three companies to track: BCBS of Montana, Montana Health COOP and PacificSource.
Fortunately (well, unfortunately, actually), all 3 of these are listed on Healthcare.Gov's "Rate Review" website, making it fairly easy to generate the weighted average. Sadly, it's grim news in Big Sky country next year:
According to their report, "100%" of South Dakota's individual insurance market products have requested double-digit rate hikes next year, which sounds bad.
However, also according to their report, "0%" of those products are seeking hikes higher than 20%.
According to Agile Health Insurance, in other words, every single South Dakota insurance plan sold on Healthcare.Gov is seeking somewhere between 10-20% hikes, right?
OK...but look what happens when you include the off-exchange "products" as well:
Basically, they looked at the total number of products (ie, collections of plans from the same insurer) in each state and broke them down by how many were seeking rate hikes of <10%, 10-20%, 20-30% and >30%, then divided those policies into the total number offered in the state.
Agile's report concludes that
Overall, 31 percent of Obamacare individual marketplace products had a double-digit rate hike proposed for 2016. Fourteen percent of Obamacare products on the federal exchange had a proposed rate hike of at least 20 percent, while 7 percent of products had a proposed rate hike of at least 30 percent.
It's important to read Mangan's opening sentence carefully, however:
