2017 Rate Changes

Me, last Thursday:

There you have it: The states which are 100% on board with the ACA exchange provisions (running their own full state-based marketplace, expanding medicaid and sticking to the original cut-off date for "transitional" policies) average around 18%. If you remove Minnesota from the equation, it's just 15.2%.

Those which implemented only one or two of the above provisions come in at around 26%. In a possibly coincidental quirk, all five fo the "halfway" state exchange states (Hawaii, Oregon, Nevada, Kentucky and New Mexico) just happen to also fall into this category as well, which is completely appropriate.

Finally, states which are fighting the ACA kicking and screaming (no Medicaid expansion, no state exchange and allowing transitional plan extensions as long as possible) are averaging around 30%.

Make of that what you will.

The other day, I posted a bunch of charts which took a look at the average percentage rate hikes in various states depending on three different criteria: Whether they expanded Medicaid under the ACA or not; whether they allowed Transitional plans or not; and whether they ran their own full exchange (as opposed to just offloading the whole enrollment platform to the federal exchange). My conclusion, which has generated a lot of response, was that there's a definite pattern here:

The states which are 100% on board with the ACA exchange provisions (running their own full state-based marketplace, expanding Medicaid and sticking to the original cut-off date for "transitional" policies) average around 18%. If you remove Minnesota from the equation, it's just 15.2%.

(sigh) OK, with three states still missing, you just knew I wouldn't rest until I was able to fill in the missing pieces of the puzzle. Sometime today, the HHS Dept. finally entered the approved rate hikes for individual makret carriers in two of those states: New Hampshire and Virginia. Louisiana is still AWOL for whatever reason.

It's important to note that sometimes the "Final Rate Increase" percentages listed at RateReview.HealthCare.Gov dont' actually end up matching the approved rate hikes found in the official SERFF databases or even at the state's Dept. of Insurance website. Normally I cross-check all three to make sure nothing weird is going on, but given that it's well past time to move on, I'm relying purely on the RateReview numbers for these states.

With that in mind, here's what it looks like in each:

 

The main focus of this Late Night with Seth Meyers segment is about how Donald Trump completely whiffed on what should have been a reasonably strong attack on Hillary Clinton: Namely, the 25% average unsubsidized individual market rate hikes which are coming next year.

In the process, however, Meyers actually did a fairly good job of summarizing the situation:

"Now, that's bad news on the surface...but it's still in line with the projections made by the Congressional Budget Office. Obviously, Obamacare is a nuanced, complicated issue that requires sober analysis and discussion...or, as Donald Trump put it..."

(Trump saying insane nonsense)

NOTE 10/29/16: For anyone who read this entry yesterday, please note that I've gone back and completely reworked all 4 the charts, along with adding a fifth one, for several reasons:

  • I had to correct an error re. Medicaid expansion (I had Iowa not expanded and Wisconsin expanded by mistake)
  • I was able to add the final approved averages for both New Hampshire and Virginia, leaving Louisiana as the only state with a "requested" average only
  • The original graphs only listed the median rate hikes for each group; they now list the actual weighted averages for each group of states
  • I even added a fifth chart which separates the states out into those which embraced all 3 provisions vs. those which only embraced 1 or 2 of them, and those which didn't implement any.

OK. I ran the numbers several different ways way back in August, when I had compiled the requested 2017 individual market rate hike averages for all 50 states (+DC). However, many things have changed since then. Not only do I have the approved rate changes for 48 states, there were a lot of other major changes along the way, including various carrier pullouts and rate filing re-submissions.

Now that the dust has settled and the 2017 Open Enrollment Period premiums are finally locked in, let's take another look at the average unsubsidized rate hikes by state, ranked by different criteria.

As noted before, I'm really trying to move onto the actual enrollment part of the 2017 open enrollment period, but I can't resist doing some more final cleanup of my Rate Hike project:

  • SOUTH CAROLINA: This is one of the 5 states which I still didn't have approved rate changes for. Today the RateReview.HC.gov site finally added in the final numbers for SC, so here's what it looks like:

Aetna was a bit tricky--the total enrollee number is actually 41,988. They dropped out of the ACA exchange but are sticking around the off-exchange market, so I had to figure out how many of those 42K are on vs. off-exchange. The answer is in this article which notes:

More than 220,000 South Carolinians rely on the federal health care law for insurance. This year, only 8,000 of them are covered by Aetna plans.

Donald Trump, 10/25/16:

Donald Trump on Tuesday claimed that the Obama administration is lying about the size of ObamaCare premium hikes, saying it put out a "phony" number.

The administration on Monday announced that the average premium increase for a benchmark ObamaCare plan will be 25 percent for 2017, a number seized on by Republicans.

But Trump took the line of attack a step farther.

“And the number of 25 percent is nothing,” the GOP presidential nominee told Fox News. “That’s a phony number, too, that’s a lie, just like everything else.”

The 25 percent number comes from a 40-page report released by the Department of Health and Human Services on Monday. It includes a four page section on its methods, as well as tables breaking down the premium increases by state and county.

Spokespeople for Trump’s campaign did not immediately respond to a request to elaborate on his comments.

Going into the fourth year of open enrollment, my work here at ACA Signups has started to fall into a seasonal pattern. During open enrollment itself, of course, it's all about the core mission of the site: Live-tracking the number of people who actually sign up for ACA exchange policies, and the related news items which accompany that. In the spring, it's all about dust settling and wrapping up: Plugging in the hard numbers, seeing how they compare with what I had projected and so on.

In the summer and fall, however, I'm on my second year of tracking the average (unsubsidized) rate increases people can expect for the following year.

For the past month or so, dozens of news stories across the political ideological spectrum have cited my estimate of the national weighted average individual market rate hikes for 2017...usually listed as 24-25%, depending on the exact date they went to press (the number has moved around slightly as additional state data has come in; it currently sits at 25.6%, although I expect it to drop back below the 25% mark once the remaining 5 states are plugged in).

However, yesterday's press releases from the HHS Dept., along with the official ASPE Health Plan Choice and Premiums in the 2017 Health Insurance Marketplace report has caused a bit of understandable confusion. Kevin Drum over at Mother Jones mentions both ASPE's 22% figure along with my own 25% estimate:

Last week I noted that with 41 states accounted for and the 2017 Open Enrollment Period quickly bearing down on everyone, it was time to pull the plug on my 2017 Average Rate Hike project and move on. I had come up with an overall national weighted unsubsidized average rate increase of around 25% for ACA-compliant individual market plans.

However, I also noted that I'd make sure to fill in the approved rates for the remaining 10 states as they came in, for completeness sake...and today, thanks to the HHS Dept. cutting the ribbon on 2017 Window Shopping at HealthCare.Gov, I've also been able to fill in the blanks for five of the remaining states all in one shot (the other five remain elusive).

The ACA exchange in Arizona has had some pretty dramatic turns over the past month or so. When the dust settled, every county in the state will still have at least one carrier offering plans on the exchange...although only one. Anyway, today the AZ DOI joined Pennsylvania and Michigan in releasing their final approved rate hikes for both the individual and small group markets:

Right on top of Pennsylvania, the Michigan Dept. of Insurance has issued their final approvals for 2017 individual and small group market rate increases. As has been pretty typical this year, the final approved rates aren't all that different from what was requested; a little nip/tuck here and there, and the 17.2% average requested has been slightly trimmed to 16.7% approved for the indy market. Meanwhile, the small group average is barely noticeable: 2.6% requested, 2.5% approved. Unlike most states, the MI DOI has already done most of the heavy lifting for me, so I don't even have to use my own spreadsheet to calculate the weighted average.

(thanks to commenters "M E" and "joe" for the heads up).

The state Dept. of Insurance has released their approved rate hikes for 2017, and it's bad news in two different ways. First, the overall full-price average rate increase looks like it'll be roughly 32.5%...over 8 points higher than the original rates requested by the carriers. Secondly, even with those higher increases, two more indy market carriers (Keystone Health Plan and Geisinger Quality Options) are pulling off the exchange, although both will continue to offer off-exchange plans.

It's important to be careful with the full carrier names here, because they often operate under several different very similar ones (Keystone Health Plans vs. Keystone Health Plan East, for instance, which is not pulling off the exchange).

So here's what's happening with each:

When I originally calculated the average requested rate hike for New Hampshire, I came up with a weighted estimate of around 13.1%. A month later, the average dropped a few points...but not for a good reason: One of the remaining ACA-created Co-Ops, Community Health Options, decided to pull out of New Hampshire (they started out as a Maine-only operation, expaneded into nearby NH for the 2nd and 3rd year, but are pulling back to Maine-only again). Since CHO would otherwise have been requesting a more than 40% increase, them dropping out actually lowered the average increase for everyone else. This obviously illustrates a major caveat with my "average rate increase" methodology: It only applies to those who are able to renew their existing plans. The moment a carrier pulls out of parts/all of a state, or drops PPOs (while keeping HMOs), etc, I have to remove a portion of the existing enrollees from the equation completely.

I noted about a month ago that Blue Cross Blue Shield of Alabama had lowered their original 39% rate hike request a bit to 36.1%. As has been the norm this year, the state regulators went ahead and approved the final request. Kudos again to Louise Norris:

For 2017, only Blue Cross Blue Shield of Alabama will participate in the exchange. In August 2016, the carrier filed rate increases for 2017 that average 36.1 percent (with a range from 20.6 percent to 38.3 percent). This was a revised rate filing, and was slightly lower than the average rate increase proposal of 39.3 percent that the carrier initially filed in June.

The Alabama Department of Insurance approved the 36.1 percent average rate increase in October 2016, and the new rates will take effect in January 2017. AL.com reports that pre-subsidy rates for Bronze plans will increase between 20 percent and 23 percent, while Silver and Gold plans will increase in price between 32 percent and 38 percent.

Blue Cross Blue Shield of North Carolina originally requested an 18.8% rate hike back in June, but after the Aetna pullout, they revised their request upwards to 24.3%. Cigna, which is expanding onto the ACA exchange next year, followed suit by bumping up their request from 7% to 15%.

I haven't seen any formal announcement from the NC Dept. of Insurance yet, but BCBSNC just posted the following blog entry announcing their 2017 rates...and it certainly looks like the 24.3% request was indeed granted as is:

Blue Cross and Blue Shield of North Carolina customers purchasing ACA plans on the individual market will see an average increase of 24.3 percent in their premiums for 2017, compared to this year’s rates. That’s higher than our original rate filing back in May (an 18.8 percent increase).

When I plugged the numbers in for Utah way back in June, I came up with a weighted average request of around 30.7%. 

Louise Norris gave me a heads up that the approved rates were in for UT, and sure enough she's correct. Not a whole lot to report, however; most of the requests were approved as is, with only minor modifications; the approved average is slightly higher:

Regular readers may be a bit confused here, as Oregon's insurance dept. had already approved 2017 rates back in early August, for a statewide average of around 23.8%.

However, as reported by Louise Norris:

But when four carriers (Atrio, BridgeSpan, Providence, and — off-exchange — Regence) agreed in August to cover a broader service area than they had originally intended for 2017, state regulators also allowed them to further increase their premiums due to the increased risk they would be shouldering. Final approved average rate increases for Oregon’s exchange carriers are as follows:

  • Atrio Health Plans: 29 percent (up from the originally-approved 20.8 percent).

  • BridgeSpan: 23 percent (up from the originally-approved 18.9 percent).

  • Kaiser Permanente: 14.5 percent (range is from 10.9 to 22 percent).

I originally estimated the requested average rate hike for Wisconsin indy market carriers back in August. I came up with a weighted average of around 20%...but this was questionable due to my not being able to come up with the actual enrollment figures for 4 of the 15 carriers in the state (note: several of these have more than one entry for different types of plans):

A couple of days ago, the Wisconsin Insurance Dept. announced the approved rate increases. Unfortunately, the articles about it don't provide hard numbers for either the rate change or enrollment figures for each carrier either, but they did provide the overall weighted average increase, which is really what I'm trying to calculate anyway, so there you go:

This is a minor update, but with all the bad rate hike news this year, I'll take any good news I can get. A couple of weeks ago, the Arkansas Insurance Dept. approved rate hikes for the 4 carriers participating in the ACA exchange next year, including significant reductions for all of them:

Now it looks like the final rate increases have been chopped down still more:

In mid-August, all of the carriers that offer plans in the Arkansas exchange proposed new rate increases for 2017, all of which were lower than their initially filed rates. Rate increases were then reduced even further for QualChoice and QCA:

There was a time, just a few months ago, when it looked like Alaska, which had already suffered from massive rate hikes the past 2 years due to their unique healthcare situation, might have a complete catastrophe on their hands with a third year of massive individual market rate hikes.

Fortunately (and to their credit), the GOP state legislature worked with the Independent governor to pass a new law which created a state-based reinsurance program to stave off the ugly hikes. In July, it looked as though this would result in not-fantastic-but-not-awful 10% average increase:

A major health insurer is seeking an average rate increase of about 10 percent on individual health insurance policies in Alaska, far less than what it received the last two years. Thisfollows recent steps by the state to shore up Alaska's insurance marketplace.

Premera Blue Cross Blue Shield is expected to be the only company offering individual health policies in Alaska in 2017, with Moda Health planning to leave that market. Premera received average rate increases of nearly 40 percent for 2015 and 2016.

As I'm sure some readers have noticed, I haven't posted any updates since Friday, which is highly unusual for me, especially with open enrollment rapidly approaching. I'm afraid that due to an unfortunate coincidence of timing, I have an outside personal commitment which will be eating up a lot of my time for the next 4 weeks; as a result, expect posts to be lighter than usual.

Anyway, Hawaii's official 2017 approved rates came out the other day (thanks to commenter "M E" for the heads up):

Kaiser's 25.9% request was approved as is; HMSA's 43.3% was shot down originally; they later resubmitted it at 35%, which was then approved.

You may also notice that I've started making sure to include UNSUBSIDIZED in the headlines for all of these rate hikes. This is vitally important to remember, even if it's only relevant to around 50% of individual market enrollees.

Last year, the average full-price rate hikes approved by state regulators tended to be several percentage points lower overall than the increases requested by carriers. This year, there's been very little of that; in most case so far, the regulators have pretty much authorized the premium rate increases as requested by carriers...and in many cases have approved higher increases than requested. As a result, the overall national averages approved have been pretty close to the requests (around 24-25% nationally).

However, Nevada is an exception to this trend. Back in early June, the weighted average increases requested were just over 15% state-wide (this was confirmed by the NV DOI a month later). Yesterday, however, the DOI released the approved rate hikes, and I'm happy to report that they lopped about 1/3 off the average hikes:

I originally looked at the requested rate hikes in Kansas back in June; at the time, the weighted statewide average was roughly 35%.

While I haven't seen any press releases or news stories about it, when I looked at HealthCare.Gov's rate review database this morning, I saw that they have fianl (approved) rate increases listed for all of the Kansas listings. In most cases the requests were approved as is; in Coventry's off-exchange plans, however, are being increased more than requested, giving the following.

I should also note that according to Louise Norris, Medica is also entering the Kansas exchange for the first time, which means there's no "increase" to list since there's no current rates to compare them to.

My original estimate for the average unsubsidized rate hikes for Delaware's individual market back in June was 30.6%. Today the DE Dept. of Insurance issued their final approved rates, including the small group market:

Insurance Commissioner Karen Weldin Stewart today released Delaware’s Qualified Health Plan average rates for Plan Year 2017.

The Commissioner recommended approval of a 32.5 % average rate increase in the individual market for Highmark Blue Cross Blue Shield of Delaware. The approved average rate increase for the small group market for Highmark’s plans is 2.74%.

Aetna Life Insurance Company received an average of 22.8 % increase in the individual market and Aetna Health Insurance Company received an average increase of 23.6 %. In the small group market, Aetna Life received an average increase of 15.2 % and Aetna Health received an average increase of 19.7 %.

I mentioned a couple of weeks ago that Blue Cross Blue Shield of Oklahoma, which had originally asked for an already-ugly 51% average rate hike, had bumped that up to a jaw-dropping 76% ask. Well, earlier this week, they got it:

Obamacare premiums will raise a staggering 76 percent on average for Oklahoma residents, and the state's top insurance regulator says the state's insurance exchange set up by the law is on "life support."

Oklahoma's Insurance Department said on Tuesday that increases in individual marketplace plans will range from 58 percent to 96 percent.

"These jaw-dropping increases make it clear that Oklahoma's exchange is on life support," said Insurance Commissioner John Doak, in a statement. "Health insurers are losing massive amounts of money. If they don't raise rates they'll go out of business. This system has been doomed from the beginning."

Huh. OK, it looks like three of the ACA state-based exchanges have already launched their 2017 window shopping tools: Idaho, Maryland and California!

The other two announced that their 2017 offerings were open for business via press releases, but it looks like CoveredCA just quietly opened the doors without any fanfare. I stumbled across this by simply visiting the CoveredCA site and clicking the "Shop & Compare" link at the top, which now lists 2017 as the default Coverage Year (you can still choose 2016 if you need to enroll for the rest of this year via SEP). Plugging in some dummy info confirms that the plans are indeed set to start on 01/01/17.

h/t to Esther F. for the heads up:

Amy Goldstein at the Washington Post writes:

Evergreen Health, Maryland’s version of the innovative nonprofit insurers created under the Affordable Care Act, decided Monday to become a for-profit company to avoid the possibility of a shutdown, according to its chief executive.   

If the switch is approved as expected by federal and state officials, Evergreen’s unprecedented move will leave standing only five of the 23 co-ops, or Consumer Operated and Oriented Plans, which started nearly three years ago.

...Evergreen, which covers nearly 38,000 Marylanders, has been trying for the past year to forge an arrangement with federal health officials to stabilize its finances. It enlisted help from the state’s congressional delegation and in June filed suit against the federal government.

As noted below, only around 8,000 are on enrolled in individual ACA exchange policies; the rest are either off-exchange or small/large group coverage.

More last-minute shuffling... (h/t commenter "M E"):

Baptist Health Plan to stop selling insurance in Ky.

FRANKFORT (AP) — Baptist Health Plan says it will not sell policies in Kentucky next year, meaning about 7,000 people will have to find a new insurance provider.

Kentucky’s fourth-largest insurer notified state officials in a letter. In a news release, state officials say company President James S. Fritz said Baptist Health Plan had enrolled more people than it planned and said federal risk assessments imposed by the federal Affordable Care Act are “unsustainable.”

The company’s insurance plans sold on the state’s health exchange will be good through Dec. 31. Plans sold off the exchange will expire March 31, 2017.

The news means next year people in 59 counties will have one insurance provider selling plans on the state health exchange. Off the exchange, most counties will have two options, state officials said.

Back in June, BCBS of Minnesota announced that they were pulling all of their PPO plans out of the state. Aside from that, and some hefty proposed rate hikes for everyone else, there hasn't been a whole lot of news out of the Land of 10K Lakes.

Today, however, they announced their approved rate increases, and the unsubsidized prices don't look pretty:

Health insurers are boosting individual market premiums by an average of 50 percent or more next year, increases that regulators say are necessary to save a market that otherwise was on the verge of collapse.

The increases were announced Friday by the state Commerce Department, and show premiums will jump even higher than proposed rates that were made public on Sept. 1.

At that point, carriers sought increases ranging from 36 percent to 67 percent. But the final average increases will range form 50 percent to 67 percent, depending on the insurer.

Here's how it actually plays out by the hard numbers:

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