Breakthrough — Utah GOP leaders reach a deal on Medicaid expansion
Republican leaders have agreed to a broad, conceptual framework for expanding Medicaid to insure tens of thousands of low-income Utahns with a plan that would call on medical providers to pay for the new health coverage.
The so-called Gang of Six — Gov. Gary Herbert, Lt. Gov. Spencer Cox, Senate President Wayne Niederhauser, House Speaker Greg Hughes, House Majority Leader Jim Dunnigan and Sen. Brian Shiozawa — huddled this week constructing the skeleton of a new Medicaid plan to replace the governor's Healthy Utah and the House's Utah Cares proposals.
On Friday, they announced their agreement, saying it was sustainable and would protect other key areas of the budget.
Before I get into the meat of the headline, I just wanted to point something out (bear with me, there's a reason for this):
Exhibit A:
October, 2013: Several million people receive cancellation notices from their health insurance companies, stating that their current policies will be discontinued effective 12/31/13 because they don't meet the Affordable Care Act's minimum coverage requirements. Much outrage and gnashing of teeth follows because President Obama had repeatedly stated that "If you like your plan you can keep it" (which, as I noted over a year ago, was an absurd thing for him to promise without including any caveats since there's no way of guaranteeing that the company won't go out of business, leave the state or simply decide to discontinue that policy for their own reasons which may or may not have anything to do with ACA compliance).
November, 2013: In response to the "You Can Keep It" brouhaha, President Obama and the HHS Dept. announce a 1-year (later quietly extended to up to 3 years) "transitional" policy for non-compliant plans. Some states take them up on it; some don't.
July, 2015: Republicans and other ACA critics complain that allowing the "transitional" policy extension is partly to blame for significant rate hikes expected to show up in 2016.
CONCLUSION: Damned if you do, damned if you don't.
Over at Balloon Juice, Richard Mayhew has posted a great piece illustrating, once again, the importance of looking past the scary headlines to find out 1) what the true picture is (ie, taking all of the rate changes into account--not just the biggest ones--and weighting them by proportionate market share), and 2) what's going on with your situation, not someone else's:
As expected, the initial ask by insurers is being revised down. It is easier for insurers to get state regulators to agree to a lower number from the initial than to get the regulators to agree to a higher number than the initial ask. That allows regulators and their champions to point to a clear example of their effectiveness at protecting the public. This is a bit of a kabuki. In my state, when Mayhew Insurance and our competitors submit rates, there is a de facto implicit fudge factor built into the rates (usually as excess reserve accumulation) that everyone expects to be cut by the third round of review.
Louise Norris has done the heavy lifting for me regarding Rhode Island's 2016 rate change requests. Then again, there's only 3 companies operating on the exchange anyway (and I don't see any other companies operating off-exchange only, so I assume that's it for the state's individual market):
Of the three carriers that offer individual plans in HealthSource RI, only one –UnitedHealthcare of New England – shows up on the rate review tool that HHS is using to publish proposed rate hikes of ten percent or higher. United is requesting an average rate increase of about 11 percent for their Compass individual plans.
Blue Cross Blue Shield had also initially proposed weighted average rate hikes of 11 percent for their individual market plans in RI, but in early July, the carrier revised their projection to a weighted average rate increase of just 7 percent. The lower rate is partially due to the fact that in the FY 2016 budget (see below), the HealthSource RI premium fee is lower than initially proposed.
Alaska Governor Sidesteps GOP-Controlled Legislature, Expands Medicaid On His Own
Alaska will become the 30th state to accept Obamacare’s optional Medicaid expansion, after Gov. Bill Walker (I)announced on Thursday that he will use his executive power to bypass the GOP-controlled legislature and implement the policy on his own.
Walker — a former Republican who has since become an Independent — has been advocating for Medicaid expansion for over a year. Implementing this particular Obamacare provision, which was ruled optional by the Supreme Court in 2012, would extend health coverage to an estimated 40,000 low-income residents in his state. Polling has found that the majority of Alaska residents agree with Walker’s position.
This may not seem like a Big Deal to anyone but myself, but I've decided to bump up my estimate of the currently effectuated ACA exchange QHP tally from 10.3 million (which is what I've been estimating ever since the March HHS report came out) to 10.4 million, where I expect it to hover until right around the point that the 2016 Open Enrollment period kicks off in November.
I'm basing this modest increase on the latest enrollment data out of 4 states: Washington, Colorado, Maryland and Massachusetts, each of which is showing stronger retention numbers (or, in some cases, net increases) since March:
Whoa, Nelly! Ask and ye shall receive...I was just sent a copy of the June report from the Massachusetts Health Connector, and there's some fasinating healthcare data nerd stuff included.
I've pasted screen shots of every page of the report below (and there's a link to the PDF version at the bottom), but here's the main takeaways:
Effectuated QHPs have reached nearly 166,000...a whopping 40,520 higher than at the end of Open Enrollment!
While the national effectuation number is likely only 2% or so higher today than it was in March (likely 10.3 - 10.4 million vs. 10.2 million), in Massachusetts it's 32% higher. There's two main reasons for this, both connected to "ConnectorCare", which is unique to Massachusetts. ConnectorCare consists of the same low-end Qualified Health Plans that anyone can purchase (ie, they're still counted as QHPs in the national tally), except that in addition to the federal Advanced Premium Tax Credits (APTC), enrollees in ConnectorCare also receive additional state-based financial assistance, making them even more attractive to enrollees. In addition, however, unlike "normal" APTC or Full Price QHPs, which are limited to the official open enrollment period for most people, ConnectorCare enrollment, like Medicaid/CHIP, is open year round. That makes a dramatic difference, as you can see below; over 85% of the net QHP enrollment increase since March is thanks to ConnectorCare additions.
In addition, MA is the only state I know of which actively reports their attrition numbers--that is, so far this year they've had 13,635 people drop their QHP policies, meaning a total of 179,557 people have selected a plan and paid at least their first monthly premium.
Assuming a 90% payment rate (confirmed for Massachusetts back in April), this also suggests that the cumulative QHP selection total should be roughly 200,000 people to date, which is only significant to me and The Graph.
When you add the MA factor to the other state-level numbers I've received from Washington State, Colorado and Maryland, this is very strong evidence that the current effectuated number as of July nationally is more like 10.4 million vs. the 10.3 million I've been assuming.
But wait, there's more! Look below and you'll see a whole mess of pie charts, bar charts and line charts, breaking out everything from Metal Level selections and Market Share by Provider to SHOP enrollments (5,247 lives covered as of July 1st) and even Dental Plans!
Not sure how this one got by me, but the Maryland Health Benefit Exchange actually released some updated enrollment numbers over a week ago:
Nearly a half-million Marylanders — 493,346 — have enrolled in quality, affordable health coverage through Maryland Health Connection for 2015.
That includes 126,346 people enrolled in private Qualified Health Plans and 367,000 enrolled in Medicaid from Nov. 15, 2014 through July 5, 2015. About 92 percent of enrollees through the state’s health insurance marketplace are receiving some form of financial assistance.
Medicaid enrollments are year-round. And while open enrollment for private health insurance for 2015 coverage ended in February, people may still enroll if they have a qualified “life event.”
The "92% receiving financial assistance" bit is slightly misleading; that's true, but only because the Medicaid enrollees are lumped in. If you're talking about QHPs only, it's more like 69% (87.2K out of 126.3K). Whether that's a good or bad thing obviously depends on your POV.
The official tally of QHP selections nationally during the 2015 Open Enrollment Period (from 11/15/14 - 2/22/15) was 11,688,074 people.
The actual number of people still enrolled in effectuated plans (i.e., active) as of March 31, 2015, according to the HHS Dept., was 10,187,197 people. That's a net reduction of exactly 1,500,877.
On the surface, that may look bad, but bear in mind that with a 90% payment rate (which I suspect is actually pretty close to the non-ACA industry standard, and which is about 2 points better than last year), that means only about 10.5 million of the original enrollees would have been expected to actually be enrolled in March anyway. That leaves another 332,000 people who presumably paid up for January, February and/or March, but had dropped their policies by the end of March.
