NOTE: This is an updated version of a post from a couple of months ago. Since then, there's been a MASSIVELY important development: The passage of the American Rescue Plan, which includes a dramatic upgrade in ACA subsidies for not only the millions of people already receiving them, but for millions more who didn't previously qualify for financial assistance.
Much has been written by myself and others (especially the Kaiser Family Foundation) about the fact that millions of uninsured Americans are eligible for ZERO PREMIUM Bronze ACA healthcare policies.
I say "Zero Premium" instead of "Free" because there's still deductibles and co-pays involved, although all ACA plans also include a long list of free preventative services from physicals and blood screenings to mammograms and immunizations with no deductible or co-pay involved.
The Delaware Insurance Dept. has posted the approved 2021 individual market rates and it's about as unexciting as you can imagine: There's a single carrier in the state (Highmark BCBS), which asked for a 0.5% average premium reduction and was approved for...a 1.0% average premium reduction. Unsubsidized Delaware enrollees will average around $80 in savings per year.
The Indy market is about as simple as it gets since there's only a single carrier offering ACA policies either on- or off-exchange (Highmark BCBS). They're actually cutting premiums on average slightly next year, by half a percent. They state in their summary that "Covid19 is expected to increase claim costs in 2021"...but that's all they have to say about it. The full actuarial memo includes an extensive section about the COVID-19 impact factor...but the numbers/percentages are all redacted:
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:
I wrote last month that Highmark BCBS, the sole individual market carrier operating in Delaware, has requested a 5.8% average premium reduction for 2020. In the press release from the state insurance department they noted:
It is important to note, that the proposed rate decrease is unrelated to Delaware’s intended submission of a 1332 Waiver to establish a reinsurance program. If the application process is successful, the actuarial consultant’s projections are correct, and the State of Delaware secures adequate funding, the waiver program may decrease rates by an additional 20%.
Dover, DE -- Highmark Blue Cross Blue Shield of Delaware (Highmark BCBS) has submitted its required annual rate filing to the Delaware Department of Insurance. After years of substantial increases, Delaware’s Marketplace has stabilized and premiums have decreased. Highmark BCBS, the only insurer continuing to offer insurance coverage in Delaware’s individual market, has proposed a 5.8% decrease for 2020. The proposed 2020 rate decrease will affect over 20,000 Delawareans.
The decrease comes after last year’s 3% rate increase and the Department’s decision to silver load. By applying the rate increase to silver level plans only, a practice known as ‘silver-loading,’ Delaware’s Marketplace received more federal subsidies, helping to assist in stabilizing the market and lowering premiums.
Legislation calls for reinsurance program to aid people with extremely high health insurance premiums
Lawmakers have introduced legislation this week that would create a reinsurance program to help lower the cost of premiums for Delawareans who do not get insurance through their employers.
House Bill 176, which has no Republican co-sponsors, would stabilize the individual health insurance market and help Delawareans struggling with extremely highhealthcare costs to get relief, a release from House Democrats stated.
Delaware is pretty cut & dried: There's only one carrier, Highmark, offering ACA policies in the state. They're requesting a 13.0% average rate increase for 2019, and yes, they call out both the individual mandate being repealed and #ShortAssPlans being expanded by Trump and the GOP.
Unfortunately, they've redacted the specific percentages caused by those factors. The Urban Institute pegs it at 19.9%, but I err on the side of caution and only assume 2/3 of that amount, or right around...13%. If accurate, that means Highmark BCBSD would be keeping rates pretty much flat next year if those changes hadn't been made.
Highmark Blue Cross Blue Shield's 2018 Affordable Care Act marketplace prices will rise by 25 percent, less than it had requested.
The insurer had asked the Department of Insurance for a 33.6 percent increase in June, one month after Aetna announced it would pull out of Delaware's marketplace. The withdrawal will end its coverage of 11,854 Delawareans and make Highmark the only insurance provider in the Delaware marketplace.
...Right now, about 27,000 Delawareans have health insurance through the marketplace. The rate increases will not affect Medicare, Medicaid or coverage by private and government employers.
...Highmark's rate request was based on the uncertain future of Obamacare, especially whether the federal government would or would not enforce the mandate that makes uninsured people either opt in or pay a tax penalty, or continue to make the cost sharing reduction payments, which helps reduce prices for low-income Americans.
Calculating the average requested rate hike in Delaware is easier than most states. This year they officially have 5 carriers participating in the individual market (3 on exchange, 2 off)...but one of those is "Freedom Life" which is a phantom carrier; another is Golden Rule which only has about 120 enrollees; and two of the others are divisions of Aetna, which is dropping out of Delaware's indy market next year altogether. That leaves just Highmark BCBS, unless Golden Rule has surprised me by enrolling a significant number of people off-exchange this year.
In Delaware, assuming 30,000 people enroll in private exchange policies by the end of January, I estimate around 20,000 of them would be forced off of their private policy upon an immediate-effect full ACA repeal, plus another 10,000 enrolled in the ACA Medicaid expansion program (PPT), for a total of 30,000 residents kicked to the curb.
As for the individual market, my standard methodology applies:
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 %.
Delaware is a small state, and only has a total of 4 carriers offering individual polcies (2 on exchange, 2 off). One of those, however, is once again "Freedom Life" which, once again, is asking for precisely a 17.37% rate hike on their almost-certain-to-be-nonexistent enrollees. So...never mind them. That leaves Aetna (split into HMOs and PPOs) and Highmark BCBS offering policies on the exchange, and Golden Rule off the exchange.
Unfortunately, I can't find Golden Rule's actual current enrollment number, but as you can see below, it really doesn't matter:
As you can see, no matter how many enrollees Golden Rule has, their 30.3% average hike request is very close to the 30.6% average of the other carriers. The very most it could do is nudge the weighted average down by a tenth of a point or two, so let's call it 30.5%.
There's an old saying: Figures lie and liars figure. Statistics and percentages are a funny thing; as politicians of every stripe know, you can often twist them to mean whatever you like, especially when you don't provide proper (or sometimes any) context whatsoever. Case in point: Yesterday's embarrassingly dishonest "chart" presented by Representative Jason Chaffetz at the Planned Parenthood witchhunt committee hearing.
For a less inflamatory example of this, consider the headline of this entry:
Delaware: *Approved* 2016 rate hikes reduced by 11.4%!!
At first glance, of course, it looks like I'm saying that after going through the regulatory approval process, the individual health insurance premium rates in Delaware are being reduced by 11.4% next year! Hooray!
Delaware's 2016 rate hike analysis is about as simple and straightforward as it gets: Two companies (Aetna and Highmark BCBS) for both the individual and small group market, both on- and off-exchange, period...and their website includes the actual affected enrollee tallies for each, giving weighted totals:
Ugh. Nearly 25% requested for the individual market, just under 10% for the small group market. Of course these are requests only, so they might be slashed somewhat by regulators yet.
Pennsylvania became the first state Tuesday to publicly put in motion a back-up plan to protect its federal health insurance subsidies in the event the Supreme Court dismantles a key part of President Obama’s health care law.
State officials say they don't yet know how enrollment is going this year in Delaware's health insurance exchange.
The Delaware Health Care Commission received an update Thursday on the second year of implementation of the Affordable Care Act.
But state health and social services officials say won't be able report any enrollment numbers until they get them from the federal government. They say they hope to see the first monthly federal report around later this month.
I did receive these oddly-worded tidbits via Twitter:
More than 23,612 Delawareans have enrolled in a #ACA plan since October 2013#netDE
No 2015 data yet, but at least this has an update to the ACA Medicaid expansion figure for Delaware, tiny though it might be:
In addition to the Health Insurance Marketplace, some residents might be eligible for coverage through Delaware’s expanded Medicaid program, which continues year-round. More than 9,000 individuals have received coverage under the Medicaid expansion in the past year.
Hmmm....like Hawaii, this enrollment update is a) tiny (small state) and b) confusing, since it means that either not a single additional person has enrolled in Delaware since April 30th (which I highly doubt), or it means that the number of people dropping out has precisely matched the number added since then (which I also highly doubt), or it means that the reporter got their numbers and dates mixed up by mashing up the 4/30 QHP total with the 8/31 Medicaid total:
As of Aug. 31, a total of 22,340 Delawareans have enrolled in coverage since Oct. 1, 2013, which Rita Landgraf, secretary of Delaware Health and Social Services, said came as a pleasant surprise to the commission.
...Of the enrollees in the health-care marketplace over the past 11 months, 7,943 individuals enrolled as part of the Medicaid expansion, an 8 percent increase from the month of July.
I still don't know why they didn't roll it out one state per day; if they'd gone alphabetically, they would have had a solid week to work the kinks out with a (relatively) low volume before hitting a big state:
Alabama, Alaska, Arizona and Arkansas are all relatively low-population.
California, Colorado, Connecticut and Delaware* are all state-run exchanges.
That means they wouldn't have hit Florida on the federal site until tomorrow.
I know that the system still would have had serious software issues, but at least they wouldn't have to deal with the massive overload of traffic at the same time that they were trying to fix the issues.
*(Obviously I was mistaken at the time about Delaware running their own exchange, but it's still a low-population state so my point was still valid...and of course the District of Columbia does run their own exchange).
Well, obviously it was too late for that at the time, and they've since scrambled to get their act together on the individual exchange side.
Remember, the HHS report from yesterday only runs through 4/19...there's still 11 days worth of data missing from most states...
DOVER, Del. (AP) — Final enrollment numbers released by state officials Thursday show that 14,397 Delawareans signed up for health insurance coverage under the federal Affordable Care Act in the first year of open enrollment.
....Health and Social Services Secretary Rita Landgraf told the state Health Care Commission that 4,217 other Delawareans were found eligible for coverage under expanded Medicaid rules the state adopted as part of an effort to reduce the number of uninsured residents.
Excellent find by contributor deaconblues; HighMark is one of the few major insurance companies which has been very open about their off-exchange QHP enrollments. This press release contains some great updates for 3 different states, including a total exchange QHP update for West Virginia (since HighMark is the only insurance company operating on the exchange there anyway):
Highmark's total enrollment* for individuals who have purchased Affordable Care Act-compliant plans both on the federal marketplace exchange and through Highmark directly:
Pennsylvania: 148,003 total with 104,324 on-exchange and 43,679 off-exchange
West Virginia: 20,131 total with 14,839 on-exchange and 5,292 off-exchange
Delaware: 13,010 total with 9,187 on-exchange and 3,823 off-exchange
Through both on- and off-exchange purchases, Highmark had a noteworthy percentage of new members, which are likely those who were previously uninsured or had insurance with a competitor.
Pennsylvania: 53 percent new members
West Virginia: 63 percent new members
Delaware: 67 percent new members
The numbers are tiny, but what the hell...DE was at 6,538 as of 3/01, so this is at least 1,463 higher...if it really is only 8,001, that's actually down 13% from the February rate, which I find hard to believe, but the numbers are so small it doesn't matter much anyway:
State officials initially had hoped to enroll 35,000 of the roughly 90,000 uninsured Delawareans for coverage under the ACA, but federal officials set a much lower target last fall of 8,000 enrollments, a benchmark that state officials say has been exceeded.
A beautiful find by new contributor Uncle Toby: Highmark Inc., a major insurer which serves Pennsylvania, West Virginia and Delaware, just did exactly what I've been wanting every insurer to do: They officially announced not just their off-exchange enrollments, but specified the exact date that these run through and the fact that they're all 100% ACA compliant.
As a bonus, they've included specific state-by-state breakdowns as well as a comparison against their on-exchange enrollments. 32% of PA's, 27% of WV's and 29% of Delaware's QHP enrollees to date have been off-exchange. This proves exactly what I've been saying: There are absolutely several million (at a minimum) direct QHPs out there which simply haven't been documented publicly yet.
UPDATE: On the down side, I was off by 4% this time around.
On the up side, I UNDERESTIMATED:
Actual Feb. enrollments: 942,833, for a total of 4,242,325 thru 3/01/14.
Sarah Kliff at Vox just announced that the February HHS report is expected to be released today at around 4:00pm. A few items in anticipation of that:
As I've noted several times, I'm projecting the report to total around 902,000 exchange-based private QHP enrollments for the month of February (technically 2/02 - 3/01)
If accurate, this would bring the cumulative total of exchange-based private QHP enrollments to 4.202 million (from 10/1/13 - 3/01/14)
From the data I have, the average daily enrollment rate in February was almost identical to that of January, which had about 1.146 million QHP enrollments. HOWEVER, the January report included five weeks of data (12/28 - 2/01), while the February report will only include four weeks (2/02 - 3/01). Therefore, even at the same daily average, it'll be about 20% lower no matter what.
If you want to get REALLY specific, call it 902,800 and 4,202,292.
I've been dead-on target 6 times in a row without hyping up my projections beforehand. This time I am hyping myself up beforehand, so I'll probably be way off...but as long as I've UNDERestimated the tally, I'll be perfectly fine with that...
The report will be released in about 5 minutes, but my kid gets home from school in about 10, so it'll be a good 20 minutes before I can really post anything. Feel free to follow Sarah Kliff of Vox in the meantime!
At a press conference today, the Secretary of the DHSS announced that Delaware's private QHP enrollments went up 38% in February while Medicaid expansion went up 55%, to 6,994 and 2,168 respectively. Not much in sheer numbers but a nice bump for a small state. This brings Delaware up to 58% of their reasonable 1st year QHP goal of 12,000.
Sec Landgraf says 6,994 Delawareans have enrolled in the marketplace through Feb. 28, up 38% from last month's report. #choosehealthDE