As anyone who's been following the ACA exchange saga over the past few years knows, the original idea was that all 50 states (+DC) would establish their own, individual healthcare exchange, including their own website/technology platform for enrolling residents in private policies (QHPs), Medicaid (supplementing or replacing whatever existing Medicaid system they already had) and small business policies (the ACA's SHOP program). In addition, each state exchange would also have their own board of directors, marketing department, support call center, fee structure for covering the cost of operations and so on.
If things had worked out that way, there would have been 51 different websites where people would enroll in ACA policies, each one independently branded.
For 2016, HMSA has proposed a 45.5 percent rate increase for their individual HMO plan, and nearly a 50 percent rate hike for their individual PPO plan (49.1 percent overall). The carrier justified their rate hikes based on claims costs, explaining that while virtually everyone in Hawaii was already insured, the uninsured pool – many of whom purchased new ACA-compliant plans – had significant medical needs.
Ouch. Yup, that's a pretty ugly requested increase, no way around it.
The following day, Kaiser proposed an 8.7 percent rate increase for their individual market policies.
If approved as is, this would have resulted in a 33.7% average rate increase, when weighted by market share between the two companies.
Hawaii Health Connector offers individual plans from two carriers: BCBS’s Hawaii Medical Service Association (HMSA), and Kaiser Permanente.
For 2016, HMSA has proposed a 45.5 percent rate increase for their individual HMO plan, and nearly a 50 percent rate hike for their individual PPO plan (49.1 percent overall). The carrier justified their rate hikes based on claims costs, explaining that while virtually everyone in Hawaii was already insured, the uninsured pool – many of whom purchased new ACA-compliant plans – had significant medical needs.
Ouch. Yup, that's a pretty ugly requested increase, no way around it.
The following day, Kaiser proposed an 8.7 percent rate increase for their individual market policies.
In 2014, Hawaii's enrollment numbers were pretty bad, but they were at least consistent: About 400 through the end of November; 2,200 at the end of December; 3,600 at the end of January, 4,600 at the end of February and about 8,600 through mid-April. Their cumulative total through the end of the off-season last year was just shy of 11,000, which again, was pretty in line with what I'd expect.
As you can see from the reposts below, for 2015, Hawaii's numbers have been all over the place, making sense some days and completely out of whack on others. The official HHS Dept. ASPE report has Hawaii with 12,635 QHPs selected for 2015 as of Feb. 21st...which sound about right to me (ie, that's a pretty lame number, but it's still around a 47% increase over 2014). Then, a few days ago, CMS released the effectuated enrollment numbers as of 3/31. For Hawaii, this number is 8,200...a 35% drop. While that's a disturbingly heavy drop (the other states averaged just a 13% "drop" overall), it's at least plausible.
For months now, the ACA state exchanges in small states like Rhode Island, Vermont and Hawaii have been struggling mightily with either funding issues (RI) or both funding and technical problems (VT & HI). Most of my own focus has been on the 2 northeastern states.
Today, however (thanks to Sabrina Corlette for the heads' up), the HI Health Connector has apparently skipped ahead a few chapters and concluded that due to their inability to convince the state legislature to pony up more cash (they were originally seeking $10 million but only $2 million was approved), they're gonna have to close up shop:
May 09--The Hawaii Health Connector has prepared a contingency plan to shut down operations by Sept. 30 after lawmakers failed to pass legislation to keep the state's troubled Obamacare insurance exchange afloat.
While this was screaming out as a big red flag, I grudgingly accepted it...only to have the rug yanked out from me when the official ASPE report came out in March, giving the official final number as 12,625...which is right in line with what I was expecting in the first place (around a 50% increase over their total in April 2014, and 17% over their total as of September 2014).
The impending King v. Burwell Supreme Court decision will cast an even larger shadow over the ACA over the next 2 months (the decision is expected to be announced in June), as exchanges in 6 of the 14 states running their own (State-Based Marketplaces, or SBMs) are at risk of either being abandoned, dissolved or otherwise moved over to the federally-run Healthcare.Gov exchange:
The federal government is threatening to take over Hawaii's health insurance exchange within months and has restricted grant money to support operations of the Hawaii Health Connector.
Jeff Kissel, the Connector's executive director, told lawmakers at a briefing Thursday that if the exchange created by the Affordable Care Act does not get state funding soon, the federal government will abolish Hawaii's marketplace and run it directly.
This isn't an exact apples-to-apples comparison, since the Massachusetts number includes the "overtime" extension period while the other 5 states only run through 2/15/15, but I thought it would be useful to see how the 6 exchanges which had widespread technical issues last year fared this time around. Obviously other states like Washington and California had some snafus, but these are the ones which were seriously hosed last year to the point of requiring massive overhauls or which were completely scrapped in favor of a new platform (I'm not including HC.gov itself here since everyone already knows what massive technical improvements they've made).
The chart below refers specifically to QHP selections only (whether paid or not), and compares the 2015 open enrollment period (11/15/14 - 2/15/15...or 2/26 in the case of MA) against the 2014 open enrollment period (10/1/13 - 4/19/14). I've also included some notes for context.
The enrollment data from Hawaii has been sporatic and a bit squirrelly, with the few numbers being thrown around sometimes including the cumulative plan selections including 2014 enrollees whether they renewed for 2015 or not. When I posted my last Hawaii update, I was suspicious (at 16.1K, it was nearly twice last year's tally), but the article seemed pretty confident about the numbers, so I went with it.
Well this one was unexpected: It's not a formal press release, but this story from the Hawaii Reporter--which actually has a pretty negative slant to it--is chock full of actual, current enrollment data points for Hawaii...and they're pretty good, relatively speaking.
None of the numbers are precise--they're all rounded off...but it's still a breath of fresh air from the Aloha state, and brings the number of states which haven't provided renewal data down from 3 to two (of course, the other two are California and New York, but still...)
...The Connector had about 1,000 people enrolled at this time last year. As of Thursday, that number had grown to 16,000.
...More than 365 small businesses, with 2,400 enrollees, have joined the Connector through the Small Business Health Options Program, or SHOP, in part because of tax deductions available to them, Kissel said.
