Alabama

As I noted recently, I've relaunched my project from last fall to track Medicaid enrollment (both standard and expansion alike) on a monthly basis for every state dating back to the ACA being signed into law.

For total monthly Medicaid enrollment, the official Medicaid.gov monthly enrollment data is only available dating back to late 2013, and it's only current through November 2020. The Kaiser Family Foundation has also compiled the pre-2014 average enrollment for each state based on the 3rd quarter of 2013. In some states I've been able to find more recent enrollment data for December 2020 or later.

As I noted a couple of weeks ago, I've relaunched my project from last fall to track Medicaid enrollment (both standard and expansion alike) on a monthly basis for every state dating back to the ACA being signed into law.

For total monthly Medicaid enrollment, the official Medicaid.gov monthly enrollment data is only available dating back to late 2013, and it's only current through November 2020. The Kaiser Family Foundation has also compiled the pre-2014 average enrollment for each state based on the 3rd quarter of 2013. In some states I've been able to find more recent enrollment data for December 2020 or later.

The American Rescue Plan does plenty to make private ACA-compliant health insurance dramatically more affordable for everyone earning more than 100% of the Federal Poverty Level. For those below 100% FPL, however, it takes an indirect approach. As I wrote a few weeks ago:

One possible "solution" would have been to simply remove the lower-bound income cut-off point for ACA exchange subsidy eligibility (that is, to lower the threshold from 100% FPL to 0%)...However, this would create two new problems: First, Medicaid is far more comprehensive than nearly all ACA plans...Secondly, if the lower-end subsidy cut-off were removed, it's almost certain that quite a few states which have already expanded the program would reverse themselves and allow Medicaid expansion to expire, in order to save the 10% portion of the cost that they have to pay.

Via the Alabama Insurance Dept:

The Alabama Department of Insurance (ALDOI) has approved the final 2021 premium rates for the Affordable Care Act Individual Market in Alabama. The rates will be effective on January 1, 2021. The two carriers in the Alabama individual market are Blue Cross Blue Shield of Alabama (BCBS) and Bright Health Insurance Company of Alabama (BHIC). In general, rates for BCBS increased five percent and rates for BHIC increased 22 percent. The actual rates and the supporting material may be found by clicking on the links below.

Unfortunately, the linked documents are still redacted and thus don't include the enrollment numbers for Bright (and this press release says nothing about the small group market), but as far as I can tell this doesn't change the averages of either market much from the preliminary filings. Assuming Bright still only has a tiny part of the market, even its 22% average increase doesn't move the needle much.

The bad news is that I still can't find any official 2021 rate filings at the Alabama Insurance Dept. website.

The good news is that both of last years' individual market carriers (Blue Cross Blue Shield and Bright Healthcare) do have listings for 2021 in the SERFF database.

The bad news is that those listings don't include actual rate filings, just some other forms.

The good news is that rate filings for every state appear to be available at RateReview.HealthCare.Gov this week.

The bad news is that the filings at RR.HC.gov appear to be incomplete so far; BCBS is listed but Bright isn't (and since I do have other forms for Bright being listed in 2021, I'm pretty sure it's not because they're pulling out of the Alabama market).

When I first ran the preliminary 2020 ACA premium rate filing requests for Alabama in August, I came up with a weighted average increase of 3.9%.

CMS has just posted the final, approved rates for Alabama's 2 carriers (Blue Cross Blue Shield and Bright Health). Both carriers had their requested rate hikes approved without any changes, but the final weighted average for unsubsidized enrollees still dropped a bit to 3.3%...because I had the wrong market share ratios. It looks like Bright has an even smaller share of the market than I thought (less than 1%), bringing the weighted average down a bit.

MLR rebate payments for 2018 are being sent out to enrollees even as I type this. The data for 2018 MLR rebates won't be officially posted for another month or so, but I've managed to acquire it early, and after a lot of number-crunching the data, I've recompiled it into an easy-to-read format.

But that's not all! In addition to the actual 2018 MLR rebates, I've gone one step further and have taken an early crack at trying to figure out what 2019 MLR rebates might end up looking like next year (for the Individual Market only). In order to do this, I had to make several very large assumptions:

Alabama only has two carriers offering Individual Market policies. Unfortunately, the rate filing forms are redacted in some states, so I'm having to patch together bits & pieces of data to try and estimate the weighted average rate changes. In the case of Alabama, the filing for Blue Cross Blue Shield lists 179,500 total individual market enrollees in 2018, but there's no data for 2019...while the filing for Bright Health Insurance (a relative newcomer to the market) doesn't list any enrollment data at all.

I'm assuming that BCBSAL holds a solid 90% of the market and that their total enrollment is around the same year over year. If so, that would give Bright around 20.5K enrollees and make the total Alabama Individual Market around an even 200,000 people. Again, assuming all of this is accurate, that means a weighted average increase of 3.9%, which in turn means unsubsidized enrollees are looking at average premium increases of around $26/month  or $312 for the year.

NOTE: This has been corrected from an earlier version.

I realize this may seem a bit late in the game seeing how the 2019 ACA Open Enrollment Period has already started, but I do like to be as complete and thorough as possible, and there were still 9 states missing final/approved premium rate change analyses as of yesterday which I wanted to check off my 2019 Rate Hike Project list.

Fortunately, RateReview.HealthCare.Gov has finally updated their database to include the approved rate changes for every state, which made it easy to take care of most of these. Making things even easier (although not necessarily better from an enrollee perspective), in three states the approved rates are exactly what the requested rates were for every carrier: Alabama, Mississippi and Utah:

Last year Alabama had only a single insurance carrier, Blue Cross Blue Shield, offering individual market policies anywhere in the state. For 2018, a new carrier, Bright Health Insurance, jumped into the AL market. For 2019, both companies are lowering rates--BCBSAL is only dropping theirs slightly, but Bright clearly way overshot the mark out of the gate and is lowering their prices by 15.5% overall next year.

Unfortunately, neither of the filings clarifies just how many enrollees either has, so I don't know what the relative market share is; I'm going to assume that BCBS held onto about 90% of the total given their monopoly hold last year and the fact that Bright is a new/unknown player in the market (not to mention the fact that Bright seems to have overpriced their first year). Obviously I'll have to change this if I receive hard numbers to the contrary.

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