Believe me, I was certain that I had finally gotten this year's Medical Loss Ratio (MLR) rebate project out of my system. I really was.
However, there was one other MLR-related issue which I've wondered about for years: The ACA requires that carriers who sell policies in the Individual and Small Group markets spend at least 80% of the premium revenue on actual medical claims (limiting them to a 20% gross margin), and 85% on the Large Group market (limiting them to 15% gross).
That accounts for around 165 million people, give or take...roughly 50% of the total U.S. population...but what about the other private (or at least semi-private) insurance markets? I'm referring, of course, to privately-administered Medicare and Medicaid plans...aka Medicare Advantage and Managed Care Organizations (MCOs).
Governor Northam Signs Executive Directive to Ensure Access to Affordable, Quality Health Care Coverage for All Virginians
RICHMOND—Governor Ralph Northam today issued Executive Directive Five, directing actions to increase the number of Virginians enrolled in quality, affordable health care coverage.
This year, Medicaid expansion is providing access to health coverage for more than 325,000 eligible Virginians who have enrolled, positively impacting their health. But meaningful health coverage remains unaffordable for too many Virginians, due in large part to federal policies that have increased cost and decreased the quality of available coverage.
Back in July, the Pennsylvania Insurance Dept. posted the preliminary/requested 2020 average premium rate changes for the individual and small group markets. The ACA-compliant individual market average increase was around 4.6%; for small businesses, the average was 9.6%.
Today they finally posted the approved rate changes for each...and the indy market average has dropped to a 3.8% increase, while the small group market has gone up just a hair to 9.7%.
(sigh) Regular readers know two things about me when it comes to Sen. Elizabeth Warren:
I'm generally supporting Elizabeth Warren in the Democratic Primary (not a full endorsement, but I've been strongly leaning her way for awhile now)...
...but I'm also not happy with her seeming 180 degree shift on how to best achieve universal healthcare coverage from her brilliant CNN Town Hall response in March to her cut 'n dried "I'm with Bernie" stance since June.
HOWEVER, for the time being at least, that seems to be where she's decided to lay her marker, so it is what it is.
The single biggest headache she's been dealing with all summer and fall, however, has been the "Will You Raise Taxes On The Middle Class" question which keeps popping up in interviews and the Democratic debates. Bernie Sanders has, to his credit or detriment, stated it plainly: Yes, his plan would indeed raise taxes on households earning more than $29,000/year.
I'm not sure how this slipped by me, but in addition to Covered California already having launched their 2020 Open Enrollment Period yesterday, five other state-based ACA exchanges are already partly open as well. That is, you can shop around, compare prices on next year's health insurance policies and check and see what sort of financial assistance you may be eligible for:
I'm not sure when the other 7 state-based exchanges will launch their 2020 window shopping tools, nor do I know when HealthCare.Gov's window shopping will be open for the other 38 states, although I believe they usually do so about a week ahead of the official November 1st Open Enrollment Period launch date.
I also noted that there's two important points for CA residents to keep in mind starting this Open Enrollment Period:
First: The individual mandate penalty has been reinstated for CA residents. If you don't have qualifying coverage or receive an exemption, you'll have to pay a financial penalty when you file your taxes in 2021, and...
Second: California has expanded and enhanced financial subsidies for ACA exchange enrollees:
Until now, only CoveredCA enrollees earning 138-400% of the Federal Poverty Line were eligible for ACA financial assistance. Starting in 2020, however, enrollees earning 400-600% FPL may be eligible as well (around $50K - $75K/year if you're single, or $100K - $150K for a family of four). In addition, those earning 200-400% FPL will see their ACA subsidies enhanced a bit.
While the 2020 Open Enrollment Period doesn't officially start until November 1st across the rest of the country, in California it begins two weeks earlier, for whatever reason:
In most states, open enrollment for 2020 coverage will run from November 1, 2019 to December 15, 2019. But California enacted legislation (A.B.156) in late 2017 that codifies a three-month open enrollment period going forward — California will not be switching to the November 1 – December 15 open enrollment window that other states are using.
Instead, California’s open enrollment period (both on- and off-exchange) will begin each year on October 15, and will continue until January 15. Under the terms of the legislation, coverage purchased between October 15 and December 15 will be effective January 1 of the coming year, while coverage purchased between December 16 and January 15 will be effective February 1.
I posted Wisconsin's preliminary 2020 rate filings in early August. Yesterday the state insurance department posted this press release, which includes the final, approved rate changes. As far as I can tell, nothing has changed (the final statewide weighted average is a 3.2% average premium reduction over last year, thanks primarily to them implementing a fairly robust ACA Section 1332 reinsurance waiver:
Gov. Evers Announces More Health Insurance Options for Wisconsinites in 2020 Ahead of Open Enrollment
Back in July, the Colorado Insurance Dept. announced the preliminary 2020 avg. premium rate changes for the individual and small group markets, including making the important point that their then-pending Section 1332 Reinsurance Waiver program, if approved, would cut down on unsubsidized premiums by over 18% on average (18.2%, to be precise, according to the CO DOI, although my own analysis based on the preliminary rate filings brought it in at a 17.5% reduction).
As you may recall, I managed to acquire all 2,700 MLR template filing spreadsheets from the CMS website a solid month before the data was made available to the public. After spending countless hours digging through them and compiling the data on a state-by-state basis, I concluded that the final breakout was as follows:
Individual Market: $769 million in rebates being paid back to 3.34 million ACA enrollees
Small Group Market: $312 million in rebates being paid back to 2.96 million enrollees
Large Group Market: $290 million in rebates being paid back to 2.31 million enrollees
TOTAL: $1.37 billion in rebates being paid back to 8.61 million enrollees nationally
