Back in March I wrote an analysis of H.R.1868, the House Democrats bill which comprises the core of the larger H.R.1884 "ACA 2.0" bill. H.R.1884 includes a suite of about a dozen provisions to protect, repair and strengthen the ACA, but the House Dems also broke the larger piece of legislation down into a dozen smaller bills as well.
Some of these "mini-ACA 2.0" bills only make minor improvements to the law, or in ways which are important but would take a few years to see obvious results. Others, however, make huge improvements and would be immediately obvious, and of those, the single most dramatic and important one is H.R.1868.
The official title is the "Health Care Affordability Act of 2019", but I just call both it and H.R.1884 (the "Protecting Pre-Existing Conditions and Making Health Care More Affordable Act of 2019") by the much simpler and more accurate moniker "ACA 2.0".
When I ran the preliminary 2020 average unsubsidized premium rate change requests for Illinois in early August, I was frustrated because I had no idea what the actual enrollment numbers for the individual carriers were, making it impossible to run a weighted average change. I had to go with an unweighted average increase of 1.4% statewide.
Fortunately, since then, not only have the final rate changes been approved and posted, I've also acquired the enrollment data, allowing for a weighted average. In the end, average unsubsidized premiums are dropping ever so slightly (0.3%)...versus going up ever so slightly (0.1%) statewide.
Cigna extended its individual healthcare exchange products for the 2020 plan year, the insurer said Sept. 18.
For 2020, individuals can purchase individual health plans in 19 markets across 10 states. The expansions will take place in counties in Kansas, South Florida, Utah, Tennessee and Virginia. The other states include Arizona, Colorado, Illinois and North Carolina.
The plans will be available for purchase on the individual marketplace during the 2020 open enrollment period, which begins Nov. 1. Plans will take effect Jan. 1.
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:
The good news is that as of August 2nd, the preliminary 2020 ACA premium rate changes are now available for every state at the RateReview.HealthCare.Gov website.
The bad news is that more carriers appear to be redacting their filings, making it more difficult to run weighted averages based on relative market share. In the case of Illinois, all five carriers on the individual market either redacted or not listed in the summary memos at all.
As a result, all I can do is run an unweighted average, which comes to a 1.4% premium increase statewide. My guess is that Blue Cross Blue Shield likely has the bulk of the market, which means the weighted average is likely just about flat.
For the small group market I didn't even bother trying to get the enrollment data; the unweighted average there is a 4.7% increase.
A couple of weeks ago I noted that the Illinois state Senate unanimously overrode outgoing Governor Rauner's veto of their bill restricting the sale of non-ACA compliant short-term, limited duration healthcare plans.
Today, I'm happy to report that the state House has followed up and overrode the veto as well:
Breaking: Just got word that the Illinois legislature has overridden the veto on SB1737 which limits short term plans to 6 months and bans rescissions of short term plans. @GtownCHIR h/t @stephanibecker
Illinois Senate voted unanimously to override the Governor's veto of a bill to limit short-term health plans to 6 months. Protecting consumers and insurance markets from long-term short-term plans does not appear to be a partisan issue. https://t.co/fJ4NVV4LRQ
I ran the numbers for Illinois' requested 2019 ACA individual market rate changes back in August. At the time, the weighted year-over-year average was a mere 0.7% increase, with Cigna and Health Alliance's 10% and 7.5% being mostly cancelled out by Celtic's 1.1% and especially Blue Cross Blue Shield's slight drop of 0.9%. Since BCBSIL holds something like 3/4 of the state's individual market share, that alone mostly wiped out the other increases.
Unfortunately, I don't have access to the hard enrollment numbers, so this was a rough estimate based on 2017's breakout. Here's what it looked like at the time:
Ensure that young adults can continue to remain on their parents’ health insurance plans until age 26
Prohibit insurers from using applicants’ gender to set premiums
Prohibit insurers from rejecting an application based on an applicant’s medical history, or imposing coverage exclusions based on pre-existing conditions.
Today, however, there were major developments regarding #ShortAssPlan restrictions (and a few other important patient protection bills) in three states: Two positive, one negative.
Illinois has the same four ACA indy market carriers participating next year as they do this year. All four rate filings specificlaly call out Mandate Repeal and #ShortAssPlans as significant factors in their rate requests, but none of them break out the actual amount, so I'm relying on my standard assumption of 2/3 of the Urban Institute's projections.
In Illinois' case, that's 2/3 of 19.4%, or around a 12.9% #ACASabotage premium increase for unsubsidized enrollees.
I should also note that only one of the four carriers (Health Alliance) specifies just how many enrollees they have; for the other three I'm basing my estimates on last year's numbers for now. The two carriers with what I assume are still the largest market share (BCBS and Celtic) are basically keeping rates flat year over year, while the other two are 7.5% and 10% apiece, for an average rate increase of just 0.7% statewide.
Unsubsidized Illinois residents are currently paying $644/month on average, so a 12.9% sabotage effect means that each of them will have to pay nearly $1,000 extra next year. Ouch.
