Over the past couple of months, the proposed 2016 individual & small business market premium rate filings have mostly been released. These are requests only, and have yet to be approved by state regulators in most states (Oregon and Kentucky are the only ones I know of which have actually approved theirs so far), but it at least gives us a general idea of where things are likely to stand next year.

One major exception to the above so far, however, has been California. The Golden State has been conspicuously absent in all of the 2016 Rate Review fuss so far. The rate review tool on their own insurance commissioner website only runs through 2015, and plugging in 01/01/2016 for California at HealthCare.Gov's rate review site brings up nothing either.

This AP article provides snippets about a handful of states; it'd be nice if they just released the actual report so we could see the hard expansion numbers (as opposed to the total increase numbers, which are still obviously useful but don't distinguish between traditional Medicaid and ACA expansion enrollees):

In Kentucky, for example, enrollments during the 2014 fiscal year were more than double the number projected, with almost 311,000 newly eligible residents signing up. That's greater than what was initially predicted through 2021. 

...At least 14 states have seen new enrollments exceed their original projections, causing at least seven to increase their cost estimates for 2017, according to an Associated Press analysis of state budget projections, Medicaid enrollments and cost details in the expansion states. A few states said they could not provide original projections.

Huh. This is kind of weird...two completely different stories, from two different reporters (although both are via the Associated Press) about the latest Medicaid expansion numbers from two of the largest states at opposite ends of the country: California and New York.

This wouldn't be surprising if there had been a major report/press release regarding Medicaid enrollment nationally broken out by state, of course, but as far as I know there hasn't been (the last report from CMS came out in early June, only runs through March and doesn't distinguish between "traditional" and "expanded" Medicaid anyway).

In any event, I'm happy to report that the numbers actually line up pretty closely with what I already had estimated for each state:

OK, this is kind of amusing. Over at right-wing nutbag-conspiracy-theory-repository/occasional-real-news site, there's an attack piece hyping up the expected 2016 individual insurance market rate increases, based on various recent articles such as Robert Pear's piece over at the New York Times last Friday, which I talked about this morning.

Needless to say, being Breitbart, they lay on the "OMG!! SKY IS FALLING!! MASSIVE RATE HIKES!!" stuff pretty thick, and as I've noted repeatedly, in some cases that may very well be true. I didn't bother reading most of it since I already know what it says.

However, there's one rather curious passage which did catch my eye:

Regulators for Covered California, the largest Obamacare exchange with 1.4 million members, have been mum on just how big their premium rate increase will be. But with the exchange already expected to lose $78 billion in the state fiscal year that began July 1, there is no state money for extra subsidies.

As I noted last week, now that the King v. Burwell debacle is behind us, all options are on the table for the future of the 13 remaining "full" state-based exchanges (Hawaii is in the process of moving over to Healthcare.Gov for 2016, joining Oregon and Nevada). The two additional state exchanges most likely to make the move are Vermont (which is having both serious technical and funding issues) and Minnesota (where neither issue is quite as bad, but still troubling). The other 11 exchanges are in considerably better shape on the technical side, but the financing situation varies widely.

Fortunately, it looks like at least one state exchange has turned the corner, or at least is pretty confident that they're about to: The largest one in the country, Covered California. They just released a report at the Alliance for Health Reform forum; for the most part it's a general overview of CoveredCA's 2015 enrollment situation, rehashing data which was already known (1.3 million currently enrolled, etc.) However, there's a few noteworthy slides which fill out the picture more completely.

This board meeting report from Covered California actually includes a few pleasant surprises! when added to the existing data:

  • The official exchange QHP selection tally in CA as of February 22, 2015 was 1,412,200
  • According to the new report, they've had a total of 117,024 QHP selections since then (through May 10th), including #ACATaxTime enrollments:

  • Add them together and you get 1,529,224 total QHP selections to date (well, as of 5/10, anyway).
  • One interesting side note: CA's final #ACATaxTime tally turned out to be nearly 10,000 higher than expected (they previously reported around 33K with just a couple of days to go in the special enrollment period; apparently a lot of people jumped in at the last second after all)

On the surface, aside from the extra 10K for #ACATaxTime, that doesn't sound too interesting...I already had CA down with 1,503,200 QHPs, so this is just 26,024 higher. Big deal, right?

Except for one thing: I've confirmed that the number below represents actual paid, effectuated enrollments as of March 2015:

The California ACA exchange, CoveredCA, released their 2016 budget today, and the outlook is...well, kind of underwhelming, frankly:

After using most of $1 billion in federal start-up money, California's Obamacare exchange is preparing to go on a diet.

That financial reality is reflected in Covered California's proposed budget, released Wednesday, as well as a reduced forecast calling for 2016 enrollment of fewer than 1.5 million people.

The recalibration comes after tepid enrollment growth for California during the second year of the Affordable Care Act. The state ended open enrollment in February with 1.4 million people signed up, far short of its goal of 1.7 million.

A number of factors contributed to the shortfall, but health policy experts said that some uninsured folks still find health insurance unaffordable despite the health law's premium subsidies.

This just in...

April 28, 2015

Those Without Health Insurance Have Three Days to Enroll in Covered California to Minimize Penalty for Being Uninsured in 2015

SACRAMENTO, Calif. — With just two days until the April 30 deadline, Covered California urged consumers on Tuesday to enroll in health coverage and announced that more than 33,000 people who signed up since February indicated they were unaware of the tax penalty for being uninsured. The 33,000 enrollees were among more than 91,000 consumers who enrolled in coverage through special enrollment since open enrollment ended in February.

OK, here's how this impacts the numbers:

Y'know, sometimes I don't even have to add anything myself:

California's insurance commissioner criticized healthcare giant Anthem Blue Cross for imposing an "excessive" rate increase on nearly 170,000 customers statewide.

Dave Jones said Wednesday that Anthem had failed to justify its 9% average rate hike that took effect April 1. Premiums are going up as much as 25% for about 4,000 policyholders.

"These rate hikes have real financial impact on Californians," Jones said. "It means less money for other essentials like food, clothing, housing and education." 

But state officials have no power to stop health insurance rate increases that are deemed unreasonable.

Jones lost his bid to change that last fall when Californians rejected the Proposition 45 rate-regulation measure by a wide margin.


As an aside:

I had read something about this a week or so ago but I didn't really think about the implications at the time.

Now that I've read it...I can't for the life of me figure out why it hasn't gotten more press. Perhaps because it hasn't actually become a law yet?

Calif. Senate bill to give health coverage to undocumented passes committee

SAN MATEO, California— A landmark bill to extend subsidized health care to some 1.25 million undocumented immigrants in California — more than one third of whom are Asians and Pacific Islanders, passed the California Senate’s Health Committee on April 15.

Senate Bill 4, also known as the 2015 Health for All Act, sponsored by Sen. Ricardo Lara (Dem-Bell Gardens) passed 7-0, according to reports by the Orange County Register.

Capital Public Radio’s KXJZ News said the bill was supported unanimously by the committee’s Democratic members, Republican members of the same committee, however, abstained from the vote.