In Utah and Idaho, G.O.P. Looks to Curb Medicaid Expansions That Voters Approved
The voters of Utah and Idaho, two deeply Republican states, defied the will of their political leaders in November and voted to expand Medicaid under the Affordable Care Act. Now those leaders are striking back, moving to roll back the expansions — with encouragement, they say, from the Trump administration.
Utah’s ballot measure, approved with support from 53 percent of voters, would expand Medicaid to cover people with incomes up to 138 percent of the poverty level — up to about $16,750 a year for an individual — and pay the state’s share with a small increase of the sales tax. Under the ballot initiative, 150,000 people are expected to gain coverage, starting April 1.
Now that I've brought everyone up to speed about my disappearing act, it's time to delve back into the ACA & healthcare developments of the past few weeks. There've been quite a few to talk about, but for now I'll just focus on updating the OE6 enrollment books a bit...starting with one of the two states which, until now, hasn't provided any 2019 enrollment data: Idaho.
Deadline to Apply for Health Insurance for the 2019 Plan Year is Dec. 15
Nine in 10 Idahoans Qualify for a Tax Credit to Help Lower Monthly Premiums
BOISE, Idaho – Idahoans wanting health insurance coverage starting on January 1, only have a few days left to enroll in a plan for 2019 with Your Health Idaho, the state’s health insurance exchange. Idahoans must complete their application by midnight, December 15 in order to have coverage at the start of the new year. In response to high demand, Your Health Idaho is extending its support center hours to help customers enroll or answer any questions.
Again, I realize that doesn't mean much of anything on its own; I haven't a clue what counts as "high demand" in Idaho or how it differs from prior years. Still, it does suggest that things are running smoothly at the Idaho exchange.
I just realized that while I've written quite a bit about the potential loss of Medicaid coverage for thousands of residents of Michigan, Kentucky and Arkansas over the past few months due to the new work requirement laws in those states, It's been far too long since I've given a shout-out to the four states which are hoping to add Medicaid expansion (or at least continue it, in one case) exactly one week from today.
For years, elected leaders in conservative states have resisted expanding Medicaid, the government health program for low-income Americans. Now voters in four of those states will decide the question directly.
The Department of Insurance received preliminary 2019 health plan information from insurance carriers on June 1 and began reviewing the proposed plan documents and rates for compliance with Idaho and federal regulations. The Department of Insurance does not have the authority to set or establish insurance rates, but it does have the authority to deem rate increases submitted by insurance companies as reasonable or unreasonable. After the review and negotiation process, the carriers submit their final rate 2019 increase information. The public is invited to provide comments on the rate changes. Please send any comments to Idaho Department of Insurance.
Idaho's insurance department website displays their annual rate filing summaries in a unique way--they don't publish the actual enrollment numbers, but they do post breakouts of the rate hikes for different metal levels (handy!) as well as the premiums brought in and claims paid out, which gives some refreshing insight into just how profitable (or not) some fo the carriers are (if I'm reading the screenshot correctly, it looks to me like BCBS and Mountain Health did just fine last year, but the other three carriers ended up in the hole (especially SelectHealth...ouch).
The state website also claims the overall weighted averge rate increase being requested in 8% even though my own spreadsheet brings it in at 9.4%. This could be due to my misestimating SelectHealth's enrollment number, or it could be because Regence Blue Shield cays they're raising rates 3.9% but the state claims it's 7% (although that should actually result in a higher average from the state, not lower...)
As noted earlier, I've been a bit lax with posting for a few days as I've worked on my latest 2-part video explainer about risk pools and #ShortAssPlans.
However, there's been a lot going on, so I figured I should try and at least do a quick update on a few items. First up: Medicaid expansion!
Here in my home state of Michigan, I've written several posts about how the GOP-controlled state legislature trying to shove through a draconian "work requirement" bill for Healthy Michigan, our name for ACA Medicaid expansion program which has been working just fine, thank you very much, for nearly 5 years now. The bill easily passed the state Senate (where the GOP holds a supermajority), and is now under consideration by the state House (where they have a smaller but still solid majority at the moment). The good news is that GOP Governor Rick Snyder--who championed passage of Healthy Michigan in the first place and seems to think it's fine mostly the way it is--is likely to veto the senate version of the bill. The bad news is that it might simply be tweaked somewhat by the House.
A week or so I noted that activists in Utah had managed to secure enough ballot petition signatures to get full, no-strings-attached ACA Medicaid expansion placed on the ballot this November...superseding legislation signed by the Governor which would otherwise only expand it to fewer than half as many people, while also imposing a work requirement on enrollees:
If approved, the initiative would require the state to expand Medicaid to people making up to 138 percent of the federal poverty level, and would prohibit enrollment caps.
Under ObamaCare, the federal government would cover 90 percent of the costs of expansion. The state share would be funded through a 0.15 percent increase in the sales tax.
...The ballot initiative would cover more than 150,000 people.
To be honest, I'm not entirely sure I understand why Idaho would do this. Yes, of course the deep red state government opposes the ACA in general and sure, they want to "lower premiums" on the individual market, but Trump's recent "ShortAss Plan" executive order would do pretty much the same thing(allowing non-ACA compliant off-exchange "Short Term/Association Plans" which amount to the same thing...without putting GOP Gov. Butch Otter's fingerprints all over the ugly stories which would soon follow if/when people started actually enrolling in these types of policies. Besides, as much as Idaho claims to hate the ACA, they seem to be quite proud (and rightly so) of their own state-based ACA exchange, Your Health Idaho.
Well, it sounds like CMS Administrator Seema Verma was thinking along the same lines, because this unexpected story broke a few hours ago: Verma sent a letter to Otter and his state Insurance Commissioner shooting down their "state-based plans" idea as being flat-out illegal.
“But the plans were on display…”
“On display? I eventually had to go down to the cellar to find them.”
“That’s the display department.”
“With a flashlight.”
“Ah, well, the lights had probably gone.”
“So had the stairs.”
“But look, you found the notice, didn’t you?”
“Yes,” said Arthur, “yes I did. It was on display in the bottom of a locked filing cabinet stuck in a disused lavatory with a sign on the door saying ‘Beware of the Leopard.”
--Douglas Adams, The Hitchhiker's Guide to the Galaxy
Over a year and a half ago, I noticed that aside from the usual names being listed as insurance carriers offering individual market policies in various states (Humana, Molina, Blue Cross Blue Shield, etc), there was one other name which kept popping up over and over again: "Freedom Life":
Now that the 2018 Open Enrollment period is officially over in every state +DC, I've started compiling more detailed demographic breakouts of the data on a state-by-state basis. The official CMS report from the Assistant Secretary for Planning & Evaluation (ASPE) report should be released at some point in the next couple of weeks, but until then, I'll have to settle for whatever reports I can patch together from some of the state-based exchanges.
So far I've dug up final (or near final) data for six states: Colorado, Connecticut, Idaho, Maryland, Minnesota and Washington State. Collectively, these states only represent about 890,000 2018 exchange enrollees, or roughly 7.5% of the 11.8 million total, so I have no idea how representative they are nationally, but it's all I have to work with for the moment.
Idaho is one of only 2 state-based exchanges which stuck with the "official" December 15th deadline for the 2018 Open Enrollment Period (the other was Vermont). Unfortunately, they haven't released an official, detailed demographic breakout report yet, but they did discuss some relevant stats in their December board meeting...which, as it happens, took place on December 15th, which means it's still missing a bit of final data. For now this is the best I can do:
d) Enrollment Update
Mr. Kelly said YHI’s goal in enrollments is to be flat year-over-year, and it is within reach. When we look at average enrollments for 2017 of around 90,000 Idahoan’s, we appear to be ahead of that for 2018. As of this morning, we have almost 96,000 enrollments. This week alone, we have gained over 6,000 enrollments, way ahead of our growth for the same time last year. We also had well over 2,100 calls into the support center yesterday.
Last year, after 7 years of doing everything in their power to undermine, sabotage and weaken the ACA, Congressional Republicans tried every which way they could to repeal the law. They tried passing AHCA , B-CRAP, ORRA, Graham-Cassidy and a few other variants along the way to no avail.
Finally, in late December, desperate for a win on "repealing Obamacare"--any type of win--they said "screw it" and just repealed the ACA's individual mandate all by itself. They didn't replace it with a reasonable inducement for people to get covered, mind you, against the advice of actuarial expert advice, mind you; they just...got rid of it.
The vote to repeal the mandate penalty was incredibly short-sighted and will almost certainly lead to negative consequences when it actually goes into effect (which won't be until next year, causing much confusion until then, but that's a different discussion)...but at least it's legal.