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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.

Over at Xpostfactoid, my colleague Andrew Sprung has been doing a great job of tracking ACA Medicaid expansion enrollment growth since the onset of the COVID-19 pandemic this past February/March at the macro (national) level, by looking at around a dozen states which have monthly reports available. He puts the overall enrollment growth rate at 23.6% from February thorugh October 2020.

Instead of replicating his work, I decided to take a closer look at individual states. The graph below shows how many Alaskans have been actively enrolled in our Medicaid expansion program (Healthy Michigan) every month since it was launched in September 2015:

Unfortunately, Alaska's 2021 rate filings aren't available via the state insurance department website or the SERFF database, and the actuarial memos posted to the federal Rate Review database are heavily redacted, so I can't run a weighted average rate change for either the individual or small group market.

The unweighted average changes, however, are a 2.0% reduction on the indy market and a 1.9% reduction for small group plans.

Louisiana's 2020 Presidential primary was scheduled for April 4th, but the other day Democratic Governor John Bel Edwards and Republican Secretary of State Kyle Ardoin agreed to reschedule it for June 20th...which is actually later than the last previously-scheduled primary in the U.S. Virgin Islands on June 6th:

The presidential primary elections in Louisiana slated for April will be delayed by two months, the latest in a series of dramatic steps government leaders have taken to slow the spread of the new coronavirus.

Secretary of State Kyle Ardoin, Republican, and Gov. John Bel Edwards, a Democrat, both said Friday they would use a provision of state law that allows them to move any election in an emergency situation to delay the primary.

The presidential primary elections, initially scheduled for April 4th, will now be held June 20th. Ardoin said in a press conference he does not know of any other states that have moved elections because of the new coronavirus, or COVID-19.

When I ran the preliminary 2020 rate changes for unsubsidized ACA policies in Alaska back in August, it was pretty easy to do...there's only a single carrier offering ACA-compliant individual market policies for 2019, which means no weighting is required. Furthermore, Premera Blue Cross Blue Shield is basically keeping their rates flat for 2020 anyway.

Moda is re-entering the market for 2020, but there's no "rate change" for them since there's no base premiums to measure against year over year.

Anyway, CMS just posted the final, approved rate changes, and Premera's number is ever so slightly higher than it was: They went from a 0.05% reduction to...a 0.03% reduction.

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:

The floodgates are now officially open for preliminary (not final) 2020 ACA rate filings for both the Individual and Small Group markets. There are several states which only have a single insurance carrier offering policies on the Individual Market, which makes it very easy to calculate the weighted average rate changes...seeing how a single carrier holds 100% of the market.

Among these states are Alaska, Nebraska and Wyoming, where the sole Indy Market carriers are once again Premera BCBS (AK), Medica (NE) and BCBS of Wyoming. Unfortunately, the rate filing forms for all three are partly redacted, making it impossible for me to determine how many total enrollees they have, although I have a pretty good estimate of the on-exchange number as of the end of March for each.

In Alaska, Premera's 2020 rates are virtually unchanged year over year. In Nebraska, Medica expects to reduce rates an average of 5.3%. And in Wyoming, BCBS is only looking to bump up average unsubsidized premiums by 1.6%.

So, it's over, right? Well...not quite. The 2019 ACA Open Enrollment Period officially ended last night...but only in 43 states. In the remaining seven (+DC), Open Enrollment hasn't ended yet2019 ACA Open Enrollment is still ongoing for nearly 10% of the population!

  • In Massachusetts, open enrollment runs through Jan. 23rd, 2019 for coverage starting February 1st

ALSO...

OK, I'm not sure how I missed this, but apparently in addition to the 7 states (+DC) which have extended deadlinesthe 2019 Open Enrollment period also isn't over for some residents of Alaska:

Alaskans living in Southcentral affected by the Nov. 30 earthquake have until Jan. 29, 2019 to sign up for health insurance through the Affordable Care Act. 

In a release from United Way of Anchorage, the Centers for Medicare and Medicaid Services announced Thursday that Alaskans living in the Municipality of Anchorage, Kenai Peninsula and Matanuska-Susitna Boroughs at the time of the quake are eligible for the extension past the original Dec. 15 deadline.

Lori Wing-Heier, director of Alaska's Division of Insurance, explained for the extension to kick in, "The caller has to call in to [healthcare.gov] and would have to attest that they could not enroll because of the earthquake."

Alaska has only a single insurance carrier offering ACA-compliant individual market plans, so it should be a piece of cake to calculate their average premium change, since I don't have to calculate the relative market share.

Unfortunately, some carriers submit multiple filings for different lines of business even if they both use the same "Actuarial Memorandum" to justify the incresae...and often times the memo itself is redacted, with the critical data (covered lives, percent increases, dollar amounts, etc.) blocked out, making it kind of useless for my purposes. Such is the case with Premera Blue Cross Blue Shield, the sole ACA market carrier in Alaska. Thanks in large part to the state's successful reinsurance program, they're dropping rates by 7% on most of their policies, and by 10.3% on the rest...but I don't know the relative portion of each, so I can't be sure what the weighted average of the two is. The second listing is for Health Savings Account plans only, so I'm assuming the bulk of their enrollees have the first types of policies, which suggests roughly an 8% overall premium drop.

(see update below)

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