Way back in October 2013, the very first official ACA Open Enrollment Period began...and was an immediate disaster for not just the federal exchange website (HealthCare.Gov), but also for about half of the states which were operating their own whole-widget ACA exchange websites.
That first year, there were 15 states doing so: California, Colorado, Connecticut, the District of Columbia (not actually a state, I know), Hawaii, Kentucky, Maryland, Massachusetts, Minnesota, Nevada, New York, Oregon, Rhode Island, Vermont and Washington State. There were oddball problems at launch with most of them, but HI, MD, MA, MN, NV, OR and VT had serious issues.
A few weeks ago, I posted a lengthy, in-the-weeds explainer about how the ACA's Medical Loss Ratio (MLR) provision works. The short version is that ever since the ACA went into effect in 2011 (3 years before newly-sold policies had to be ACA compliant), to help reduce price gouging, insurance carriers have been required to spend a minimum of 80% of their premium revenue (85% for the large group market) on actual medical claims.
Put another way, their gross margins are limited to no more than 20% (or 15% in the large group market). Remember, that's their gross margin, not net; all operational expenses must come out of that 20% (15%). The idea is that they should be spending as much of your premium dollars as possible on actual healthcare, as opposed to junkets to Tahiti or marble staircases in the corporate offices, etc. Anything over that 20% (15%) gross margin has to be rebated to the policyholder.
A few weeks ago, I posted a lengthy, in-the-weeds explainer about how the ACA's Medical Loss Ratio (MLR) provision works. The short version is that ever since the ACA went into effect in 2011 (3 years before newly-sold policies had to be ACA compliant), to help reduce price gouging, insurance carriers have been required to spend a minimum of 80% of their premium revenue (85% for the large group market) on actual medical claims.
Put another way, their gross margins are limited to no more than 20% (or 15% in the large group market). Remember, that's their gross margin, not net; all operational expenses must come out of that 20% (15%). The idea is that they should be spending as much of your premium dollars as possible on actual healthcare, as opposed to junkets to Tahiti or marble staircases in the corporate offices, etc. Anything over that 20% (15%) gross margin has to be rebated to the policyholder.
It's even conceivable--unlikely, but conceivable--that a few years from now, after 1) The ACA has become even more firmly entrenched nationally; 2) the software/technology for running a state exchange has become even more streamlined, simplified, faster, easier to use, cheaper, etc etc; and 3) (hopefully) some changed attitudes/changed administration officials (ahem), a few states on HC.gov now may even decide to go ahead and move onto their own "full" exchange/website after all...completely of their own volition.
Nevada's Silver State Health Insurance Exchange took the first step on Thursday to getting out of the federal healthcare.gov system and build its own exchange.
Governor Raimondo’s proposed FY 2020 budget called for the creation of the Health Insurance Market Integrity Fund, which would make available reinsurance payments to health plans to reduce the burden of high cost claims on individual market premiums. According to insurer filings, the enactment of the Health Insurance Market Integrity Fund would reduce the individual market premium requests from 6.6% to -0.4% for BCBSRI and from 5.4% to 1.7% for NHPRI. These insurers’ pricing assumptions are subject to review and verification by OHIC. Table 1 shows the requested individual market rate increases with and without reinsurance.
I've written many times before about how polling on the issue of "Medicare for All" has consistently proven that many Americans are confused about what the phrase actually means.
While a majority of the country keeps saying they want "Medicare for All", poll after poll has shown that a huge chunk of those who say so think it means "Medicare for All Who Want It"...that is, they think it refers to a Public Option, where it's up to them whether their major medical coverage would be public or private. This is true even among Democrats, who obviously support the concept in higher numbers than Republicans or Independents.
About five weeks ago, around the 3rd week of July, regular readers may have noticed that my output both here as well as on Twitter dropped off considerably for a week or so (much to the relief of some, I'm sure).
I made a vague reference or two to "dealing with a personal crisis" while also reassuring folks that it wasn't anything tragic (no one died, got terribly sick, divorced, etc), but didn't get into any details.
For reasons which will soon become clear, my wife was not thrilled about the idea of my sharing our little saga with the world...at least not until we were 100% certain it had been resolved.
More specifically, while she agreed that there was a legitimate healthcare angle to justify posting something about it on my site, she wanted me to wait at least five weeks before going public...namely, yesterday.
As it happens, yesterday also just happened to be the exact date that the Twitterverse exploded with two major stories related to...bed bugs.
