Idaho

I'm not sure how this slipped by me, but in addition to Covered California already having launched their 2020 Open Enrollment Period yesterday, five other state-based ACA exchanges are already partly open as well. That is, you can shop around, compare prices on next year's health insurance policies and check and see what sort of financial assistance you may be eligible for:

I'm not sure when the other 7 state-based exchanges will launch their 2020 window shopping tools, nor do I know when HealthCare.Gov's window shopping will be open for the other 38 states, although I believe they usually do so about a week ahead of the official November 1st Open Enrollment Period launch date.

Not much to see here...in August, the Idaho Insurance Dept. posted their preliminary 2020 average rate changes for the individual & small group markets; they averaged 7.0% and 4.0% increases respectively. Today they've posted the final/approved rates, and the indy numbers have been whittled down ever so slightly:

(SIGH) OK, apparently the Kaiser Family Foundation has been working on the same project as I have for the past couple of weeks, so this is no longer "exclusive"...ah, well...

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:

This just in from the Idaho Insurance Dept:

Individual Medical Plans

The Department of Insurance received preliminary 2020 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 2020 increase information. The public is invited to provide comments on the rate changes. Please send any comments to Idaho Department of Insurance.

Your Health Idaho, the only red state standalone ACA exchange in operation since Kentucky's kynect exchange was shuttered a few years back, doesn't post updates very often, but when they do there's usually a few noteworthy items. Back in March they held a semi-annual board meeting which included a few items:

8. OPEN ENROLLMENT 2019 UPDATE

Mr. Kelly said YHI’s effectuations as of the end of January are just over 101,000 and prelim February results at 98,700. There were significant enrollment shifts between the carriers specifically with SelectHealth gaining membership due to a low-price position. Modest growth continues for the dental carriers overall with significant growth for Delta Dental. Strong seasonality is seen in effectuation trends in January and February. And as expected, the average premium is just under $500 which was anticipated with the rate increase of about 5 percent.

A week or so ago there was an important ruling by a federal judge which shot down Medicaid expansion work requirements in two states (Arkansas and Kentucky) while also having a ripple effect in two more (Idaho and Iowa):

The [Idaho] Senate Health and Welfare Committee voted 7-2 to hold in committee a House bill that would create a work requirement for Medicaid expansion beneficiaries — after lawmakers found out during the hearing that a federal judge had just struck down Medicaid work requirements in Kentucky and Arkansas.

Meanwhile, a Senate bill that would create a voluntary job training requirement for Medicaid expansion beneficiaries is still in that chamber’s amending order and could come up soon. The Medicaid budget for 2019-2020 is still being held in the full House. And Gov. Brad Little has said he won’t let lawmakers adjourn for the year until Medicaid expansion and funding is resolved.

So much crazy healthcare policy/legal news is happening this week I'm having trouble keeping up.

This happened yesterday:

BREAKING: federal judge strikes down Kentucky's Medicaid work requirements. Again. Remands them back to HHS

— Nathaniel Weixel (@NateWeixel) March 27, 2019

Same judge also strikes down work requirements in Arkansas

— Nathaniel Weixel (@NateWeixel) March 27, 2019

And since I was too swamped with other stuff, I didn't have a chance to write about it until now. A bunch of other outlets have already posted the details, so here's Dylan Scott of Vox.com to save me the trouble:

A federal district judge has blocked Medicaid work requirements approved by the Trump administration in Arkansas and Kentucky.

Ugh:

CMS gives thumbs-up to Medicaid work requirements in Ohio

The Centers for Medicare & Medicaid Services has approved a waiver request for work requirements in Ohio’s Medicaid program.

...CMS rolled out guidance on these waivers in January 2018, and since then eight states, including Ohio, have had requests approved. Several additional states have submitted waivers that the agency has yet to weigh in on.

...Arkansas is the only state where such work requirements have formally been launched, and in the last several months of 2018, more than 18,000 people lost Medicaid coverage as a result of the work requirement. The Kaiser Family Foundation estimated that most of these losses were a result of the administrative requirements associated with reporting work hours.

Double Ugh:

I'm rather late to the game on this issue, but it looks like the story is already making major headlines elsewhere so I don't feel too bad; via Robert Pear of the NY Times:

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.

According to this press release from December 28th, Your Health Idaho, their ACA exchange, not only surpassed last year's enrollment total of 94,507 QHP selections by over 9%, they managed to break their all-time enrollment record of 101,073 set back in 2016:

More than 103,000 Idahoans Enroll in Health Insurance for the 2019 Plan Year

OK, this "news" isn't remotely worth a full blog entry, but what the heck; Idaho has been radio silent since Open Enrollment started, so any news out of the Great Potato state is welcome:

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.

Bloomberg News has a pretty good overview:

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.

Last month, the Idaho Insurance Department posted the preliminary 2019 ACA individual market rate change requests. They were pretty straightforward, averaging around an 8% increase across the market.

A few days ago, the Idaho DOI issued their final/approved rate changes, knocking a few points off the hikes and bringing the weighted average increase down to 5%:

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...)

I know this is like the third "It's on the ballot!" post I've written regarding Medicaid expansion in Idaho, but this time it appears to be for real...almost:

BOISE — A Medicaid expansion proposal has passed the signature threshold, officials confirmed on Thursday, but said further review is needed before it gets on the November ballot.

Ada County Chief Deputy Clerk Phil McGrane says county clerks across the state have verified roughly 58,000 signatures that organizers submitted earlier this month.

The effort needed at least 56,192 signatures to qualify. However, those signatures must also come from 6 percent of the registered voters in at least 18 of Idaho’s 35 legislative districts.

McGrane says it’ll be up to the state to determine if the signatures meet the legislative district requirements.

Reclaim Idaho, the group that organized the Medicaid expansion effort, did not immediately return a request for comment.

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