I planned on posting about this earlier today, but had to deal with a crisis for one of my Day Job clients (yes, I still have one believe it or not).

Early this afternoon, Covered California, the largest state-based ACA exchange in the country, held a conference call accompanied with a lengthy press release and a very nice slideshow full of pie charts and data points, giving a comprehensive overview of where things stand in the Golden State.

With 47 states plus DC under my belt, at this point I'd say I have a pretty good feel for the overall national premium rate increase scene; it still looks like around 12-14% nationally on average, ranging from a low of under a 1% average hike in Maine and Indiana to a high of 40% or so in Alaska and Minnesota.

However, I admit it would be nice, as a point of personal pride, if I could squeeze in the last three states: Nebraska, Pennsylvania and Wisconsin. Fortunately, Louise Norris has brought to my attention the fact that the Nebraska Dept. of Insurance has issued the final approved rate changes for the individual market:

I've said before that there are a few areas of the ACA which I simply don't consider myself knowledgable enough about to try and explain to others in depth. One of these is the so-called "Cadillac Tax" on high-end employer sponsored insurance policies. The other (well 3 others, really) are the "3R" programs which were set up to try and smooth out the transition period for insurance carriers for the first few years. The "3 R's" are "Risk Adjustment", "Reinsurrance" and "Risk Corridors".

Since I don't know much about them, here's a quick explainer from the Commonwealth Fund. A summary version is below:

Risk adjustment is a process that deters insurance plans from trying to attract healthy enrollees (“cherry picking”), and protects companies that may—by chance or because of their particular benefits—attract sicker than average customers (“adverse risk selection”). Though the Affordable Care Act bans carriers from turning people down or charging them more based on their health, the incentive to attract healthier enrollees remains because healthier customers increase profits by reducing companies’ payouts.

This is really more for budget wonks than healthcare wonks, but still kind of interesting: The Congressional Budget Office just issued their September 2015 Monthly Budget Review report. Since the fiscal year runs from October through September each year, this means that they're basically closing the books on 2015 from a budgetary POV:

The federal government ran a budget deficit of $435 billion fiscal year 2015, the Congressional Budget Office estimates—$48 billion less than the shortfall recorded in fiscal year 2014, and the smallest deficit recorded since 2007. Relative to the size of the economy, that deficit—at an estimated 2.4 percent of gross domestic product (GDP)—was slightly below the average experienced over the past 50 years, and 2015 was the sixth consecutive year in which the deficit declined as a percentage of GDP since peaking at 9.8 percent in 2009. By CBO’s estimate, revenues were about 8 percent higher and outlays were about 5 percent higher in 2015 than they were in the previous fiscal year. CBO’s deficit estimate is based on data from the Daily Treasury Statements; the Treasury Department will report the actual deficit for fiscal year 2015 later this month.

This is a pretty minor 2015 exchange enrollment update, and one of the last ones I'll be doing before the 2016 Open Enrollment period kicks off, but I should squeeze it in:

From October 1, 2013 to September 23, 2015, 166,789 people have enrolled in health insurance coverage through DC Health Link in private insurance or Medicaid:

  •  24,663 people enrolled in a private qualified health plan,
  •  120,739 people have been determined eligible for Medicaid, and
  •  21,387 people enrolled through the DC Health Link small business marketplace (includes Congressional enrollment)

As always, the DC exchange insists on giving cumulative totals since 10/1/13 instead of the 2015-only numbers, which isn't particularly useful. However, by comparing it against their earlier update, I can figure out the difference since then:

From October 1, 2013 to June 7, 2015, 125,478 people have enrolled in health insurance coverage through DC Health Link in private insurance or Medicaid:

Hmmm...this is an unexpected development:

Looking to change health plans for 2016? Member renewal begins on October 12. http://t.co/3OVo9UaOpA pic.twitter.com/33eCPY0H5P

— Covered California (@CoveredCA) October 7, 2015

The tweet includes this graphic, which seems pretty clear cut to me:

I noted yesterday that 3 states (Maryland, Idaho and California) have already opened up window shopping to prospective 2016 enrollees.

However, it was my understanding that no one was allowed to actually enroll (ie, "select or renew a Qualified Health Plan") until 2016 Open Enrollment officially starts on November 1st.

Not sure why this is being treated as such a revelation this morning, but Public Policy Polling just released new, extensive national polling results, and among the various topics they asked about was this bit regarding the Affordable Care Act:

Evidence continues to mount that the Affordable Care Act is just not a liability for Democrats anymore. Nationally we find that 42% of voters support it to 40% who are opposed. Those numbers are in line with what we've found in most swing states where we've polled on it over the course of this year. It's a far cry from when we used to consistently find voters opposed to it by a 10-15 point margin nationally and in key states. One big reason for the change is that Democrats (73%) are more unified in their support of it than Republicans (70%) are in their opposition to it. There isn't the sort of pro GOP intensity gap on the issue that there used to be.

For all of the improvements made to the federal exchange website, HealthCare.Gov, last year (ie, reducing the number of account creation screens from over 70 to just 16; optimized formatting for smartphones; working properly in general), there were still several major features missing. According to a new AP story, at least two of these have been addressed for the 2016 Open Enrollment period starting November 1st:

Consumers shopping on the government's health insurance website should find it easier this year to get basic questions answered about their doctors, medications and costs, according to an internal government document.

A slide presentation dated Sept. 29 says HealthCare.gov's window-shopping feature is getting a major upgrade.

...Previously, it could take considerable digging to find out plan details. Now consumers would be able to enter their doctors, hospitals and medications as they browse online. When they go to compare plans, they would see whether those doctors, hospitals and drugs are covered.

A few days ago I noted that the Maryland Health Connection has officially launched window shopping for the 2016 open enrollment period (#OE3).

As it happens, at least two other state-based exchanges have done so as well:

COVERED CALIFORNIA: It's pretty obscure for the moment, but if you click the "Shop & Compare Tool" link at the lower left-hand corner of the CoveredCA website, you'll be given the option to shop around for 2016 plans (you can also choose 2015 plans in case you've had a qualifying life change and need coverage for the last 2 months of this year, or even 2014 plans if you still need that information for tax purposes or whatever):

YOUR HEALTH IDAHO:

Anonymously Shop and Compare Health and Dental Plans on Your Health Idaho

Ugh. Back in August I ran a ballpark estimate of the requested average rate hikes on the North Carolina individual market, and came up with 27% like so:

However, since then, 2 major NC insurers have revised their request upwards even further:

Two more health insurers in North Carolina are asking to increase their already-proposed rate increases. 

UnitedHealthcare, which had requested an average rate increase of 12.5 percent, now is asking regulators to allow an an average increase of 20.4 percent. The range is 2.5 percent to 50.3 percent.

Humana had requested 11.3 percent and is now asking for an average of 24.9 percent. 

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