A few weeks ago I reported on some weirdness in New Hampshire's monthly exchange QHP enrollment data. They were showing an unusually high effectuated enrollment drop-off between March and April, especially odd considering that enrollment had supposedly increased from February to March.

It turned out to be a clerical error on the part of one of the carriers; this has since been corrected (though the earlier months were left as is), so the May report which was just released is back on track:

A week or so ago, I reported that Connect for Health Colorado's monthly enrollment report contained some very confusing numbers:

Last month I noted that, assuming I was reading Connect for Health Colorado's monthly dashboard report correctly, they were down to 115,890 effectuated exchange enrollees as of 3/31/16, or a whopping 23.1% lower than the official APTC report tally of 150,769 QHP selections as of the end of Open Enrollment.

...The 121,962 number at the top seems to be the one I want...except that it also includes SHOP and standalone Dental enrollments (I think).

...OK, so 121,962 includes SHOP, which has a maximum tally of 2,897, which means that the effectuated number as of 4/30/16 could be as low as 119,065...except that "Individual" could also potentially include standalone dental plans, confusing the issue further. Even worse, it says that this "Includes those who effectuated in the current plan year and later terminated a policy".

I can't tell whether that means that those who terminated their policies have been subtracted from the total (accounted for) or if they're included in the total (cumulative).

Like most states, Vermont does have an account with the SERFF database system for insurance rate filings. Until today, I assumed that they just hadn't posted the 2017 filings yet, since there's only one unrelated listing there at the moment.

However, thanks to an anonymous tipster for reminding me that Vermont also has their own, in-house rate review website...and the state is pretty easy to run the math on due to the fact that....

  • There's only 2 carriers in the state even offering individual or small group policies at all,
  • Under state law, all individual/small group policies have to be sold on the ACA exchange anyway, and
  • Unlike most states, Vermont is apparently requiring that the risk pools for individual & small group policies be merged, so there's only 1 set of rate changes his year (last year they did have slightly different average rate hikes for the two markets).

Anyway, here's the deal:

Last week there was much hand-wringing among many (including myself) about the potential fallout if the House Republicans do end up eventually winning House v. Burwell.

Today, Nicholas Bagley, who's been my guide throughout the weird convolutions of this case (the impact would actually more complicated than that of last year's King v. Burwell if the GOP had won that case) clarifies a few points and helps walk folks (including myself) back from the edge:

The HHS and Urban studies rest on the assumption that insurers will eat the costs of eliminating the cost-sharing reductions. As I’ve explained before, though, that’s not a realistic assumption.

Amazing, but utterly predictable:

Despite bitter resistance in Oklahoma for years to President Barack Obama's health care overhaul, Republican leaders in this conservative state are now confronting something that alarms them even more: a huge $1.3 billion hole in the budget that threatens to do widespread damage to the state's health care system.

So, in what would be the grandest about-face among rightward leaning states, Oklahoma is now moving toward a plan to expand its Medicaid program to bring in billions of federal dollars from Obama's new health care system.

What's more, GOP leaders are considering a tax hike to cover the state's share of the costs.

"We're to the point where the provider rates are going to be cut so much that providers won't be able to survive, particularly the nursing homes," said Republican state Rep. Doug Cox, referring to possible cuts in state funds for indigent care that could cause some hospitals and nursing homes to close.

A few days ago, I noted that Premera Blue Cross was asking for a 19.6% average rate hike for ACA-compliant individual policies in Washington State, while also pulling out of several WA counties entirely.

Today, the Washington Insurance Commissioner issued a press release with the full, weighted average rate hike requests for the individual market (including both on and off-exchange carriers):

13 health insurers file 154 plans for 2017 - 13.5 average requested rate change • May 16, 2016

OLYMPIA, Wash.– Thirteen health insurers have filed 154 individual health plans for 2017 both inside and outside of the Exchange, Washington Healthplanfinder. The average requested rate change based on enrollment is 13.5 percent.

Last year, Maryland's individual market saw rate hike requests average roughly 20% overall. For 2017, it doesn't look quite as bad on a percentage basis (although obviously the actual dollar increase is still on top of last year's):

Health insurers seek rate increases in Maryland as United Healthcare quits market

...United Healthcare, the nation's largest insurer but a bit player in Maryland, was not included on a list released Friday by state regulators of companies seeking rate increases for 2017.

Insurance Commissioner Al Redmer confirmed that the company was leaving the exchange created under the Affordable Care Act, as it has in most states across the country. It will continue to offer plans in the small-business market.

The dominant carrier on the individual market in Iowa is Wellmark BCBS, which had 137,000 enrollees (something like 75% of all the market) last year.

However, there were two important caveats to that: First, Wellmark isn't currently participating on the ACA exchange; all of those enrollees were off-exchange only. Secondly, at the time I had no idea how many of them were ACA-compliant and how many were "grandfathered" or "transitional" policies, which aren't ACA compliant and which, more significantly, aren't part of the same risk pool.

Well, Wellmark just announced that they will finally be jumping onto HealthCare.Gov for 2017. This is great news, not just because they're the dominant carrier in the state but also because it'll help fill the hole created by UnitedHealthcare dropping out.

HOWEVER, I suspect that today's news may also help explain their reasoning (I'll get to that later):

As with California, there's no actual individual carrier rate/market share breakdown available, but the source is the DOI itself, so I'm assuming "average" means weighted average:

Fifteen health insurers want an average 17.7 percent increase in premiums for Affordable Care Act individual plans, Florida officials said Thursday — higher than last year’s approved average of less than 10 percent.

...In Florida, 15 companies also asked for an average 9.6 percent increase for small group plans, said Amy Bogner, spokeswoman for the state’s Office of Insurance Regulation.

The companies were not identified individually because they claimed trade secrecy, she said.

It sounds like BCBS of Florida is seeking around 9.8 - 11.6% hikes for the individual market, and 5.2 - 8.7% hikes for the small group market:

NOTE: SCROLL TO BOTTOM OF ENTRY FOR UPDATES!

Regular readers know that I spent countless hours last summer tracking down the requested average 2016 rate change filing forms for every single state in the country, and then compiling them into my best guesstimate about the overall, weighted average rate changes for the individual policy market in each state and nationally.

In the end, I came up with a national projected weighted average increase of 12-13%, although I also made sure to note that I expected the effective average to only be around 9% after the dust settled...due to people shopping around.

As it happens, I turned out to be pretty much dead on target: The "presumptive" average (ie, assuming every single enrollee stayed with the same policy whenever possible) ended up being 11.6% nationally, while the effective average ended up being 8%.

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