2020 OPEN ENROLLMENT ENDS (most states)

Time: D H M S

Indiana

A couple of weeks ago, my post on Indiana's average 2016 rate increases on the individual market would likely be very close to flat, based on partial enrollment data (i.e., they provided the rate data for every insurance company, but enrollment data for only one of them). The one company they provided enrollment information for, Physicians Health Plan, also happens to have the highest average rate hike, 13.5%.

However, I noted that since a) Physicians only holds around 4% of Indiana's market, and b) several of the other companies were approved for rate decreases (up to -19% for Mdwise Marketplace), it's entirely possible that the state could be looking at an overall rate decrease, or a very low increase at worst. I decided to split the difference and go with a flat zero percent change until further notice.

Today, Louise Norris has come through again:

Last year, while most state-wide average premium rates increased somewhat (averaging around 5.5% overall nationally, give or take), there were a few states which actually saw rate decreases from the year before: Arkansas, Mississippi and New Mexico saw overall decreases on their individual markets, while the District of Columbia and Hawaii saw decreases on their Small Business markets.

A few weeks ago I reported that Indiana's implentation of the ACA's Medicaid expansion provision, which kicked off at the end of January, was already up to 237,000 enrollees.

Today, that number is significantly higher yet:

Industry representatives say Indiana's expanded health care program for low-income residents has functioned smoothly in the months since it was implemented following federal approval.

The federal Centers for Medicare and Medicaid Services in January approved expanding the existing Healthy Indiana Plan into a larger program that Gov. Mike Pence has dubbed HIP 2.0. That program uses federal Medicaid funds under President Barack Obama's health care law to cover people with incomes under 138 percent of the federal poverty level.

State enrollment in HIP 2.0 has climbed to nearly 290,000 participants, with about 60 percent of those people under age 40, according to state figures presented Thursday during a public hearing in Indianapolis on the program.

Yes, with the All King v. Burwell, All The Time® mindset this month, it's easy to forget that the core purpose of this website is supposed to be to track the enrollment numbers...and between KvB and this being the middle of the off-season, it's no wonder that there hasn't been much of that lately.

With that in mind, thanks to Andrew Sprung for this tidbit...Indiana is one of the states which initially refused to expand Medicaid under the Affordable Care Act, but which came around earlier this year, starting enrollment in their (heavily modified) Medicaid expansion program at the end of January.

Five months later, it looks like it's off to a pretty good start:

"The Healthy Indiana Plan ... is aspirational," said Brian Neale, the governor's health policy director. "We believe that individuals, if offered the opportunity, will make the right choices."

This Just In...

Gov. Pence gets federal OK for Medicaid alternative

Indiana has been given the green light to expand its Healthy Indiana Plan, which would offer insurance to an additional 350,000 Indiana residents who currently lack insurance.

The state will begin taking applications immediately for its so-called HIP 2.0 plan, for which coverage begins Feb. 1, Gov. Mike Pence announced Tuesday morning at a packed speech at St. Vincent Health.

So, what makes this different from standard Medicaid expansion?

Indiana is the only state to apply private market measures, such as requiring participants to make monthly contributions to help cover the benefit.

Anyone who falls below 138 percent of the federal poverty level will now be eligible to enroll in what the state is terming the Healthy Indiana Plan Plus. The plan includes dental and vision benefits, as well comprehensive prescription drug benefits.

Participants in this plan will be expected to make contributions of between $3 and $25 per month, or about 2 percent of the annual income for the year.

Rounding out today's "Net QHP Attrition Rate" Trifecta is Indiana, which, while not as deep-red as Tennessee, a) also has a Republican administration; b) hasn't expanded Medicaid; and c) refused to set up their own exchange.

This makes it all the more of a positive surprise to see that their ACA exchange QHP attrition rate is even lower than Tennessee--in fact, it's under 1%!!

The April 19, 2014 total for Indiana was 132,423 Hoosiers. Assuming an 88% payment rate and you get about 116,500.

I just learned that the number currently enrolled as of mid-October stands at 115,800...a drop of just 0.6%.

This piece by Salon's Simon Maloy pretty much nails it on the head:

At this point it’s near-impossible to maintain the fiction that the Affordable Care Act is failing or that the Republicans have a coherent strategy for unmaking it. One by one, Republican-led states are abandoning their opposition to implementing the ACA.

This is obviously an unwelcome trend for groups like Americans for Prosperity, the Koch brothers’ main outlet for political activism.

...Now contrast AFP’s treatment of Pence with how the group reacted to Rick Snyder, the Republican governor of Michigan...AFP Michigan opposed the plan from the get-go.

...So what explains the disparate treatment? It may be that AFP is finally starting to see the writing on the wall and coming to grips with the slow, steady erosion of the Republican anti-Obamacare bulwark. But it could also be the fact that Mike Pence is the Koch brothers’ golden boy.

Presented without comment (except for my emphasis):

INDIANAPOLIS (AP) — Indiana residents will have more than triple the number of health insurance plans to choose from when the federal insurance exchange enrollment period starts in November, according to a state official.

Indiana Department of Insurance attorney Tina Korty told a legislative panel Thursday that some insurers took a “wait-and-see” approach during the first year of the exchanges under the Affordable Care Act.

Nine companies will offer a total of 975 plans - not all will be available in every county - for Indiana residents on the federal exchange, she said. During the 2013-14 period, three companies offered 278 plans, The Times of Munster and the Post-Tribune reported.

“I think a lot of companies were waiting to see how the first year went,” Korty said. “Also were seeing some smaller providers that may offer a policy in only a few counties.”

Korty said a 5 percent average increase in exchange premiums is expected on Indiana policies.

Don't let the snarky headline fool you; I'm still very much a single-payer guy. However, anyone who still claims that the ACA exchanges are "socialized medicine" doesn't have the slightest clue what they're talking about. In case you needed even more proof that the ACA is very much private-market friendly:

Illinois:

After sitting out the first year, UnitedHealth Group Inc. intends to offer individual policies on the Illinois health insurance exchange next year, according to sources familiar with the company's plans.

The decision by UnitedHealth, the nation's largest and the state's No. 2 insurer, has the potential to shake up the Illinois market, which was dominated in 2014 by Blue Cross and Blue Shield of Illinois, the state's dominant insurer.

...United's participation also could help lower rates for consumers, a key concern among the law's supporters.

While United would neither confirm nor deny its plans to offer policies in Illinois next year, a spokesman said the Minnesota-based insurer intends to increase its participation over time in exchanges nationwide.

OK, this doesn't really change the numbers beyond a couple hundred, but it's encouragingto see that my "15% in Non-Expansion States" rule of thumb for estimating the number of people who fall into the "woodworker" category seems to be pretty accurate, at least in Indiana:

Even without expanding eligibility for Indiana Medicaid, the program had enrolled 40,577 more Hoosiers as of March than it had in the same month last year.

More than 15,000 of that year-over-year increase occurred in March alone this year, as a flood of people here and nationally sought coverage before Obamacare would hit them with a tax for going uninsured.

If you take a look at the Medicaid Spreadsheet, you'll see that I currently have the "woodworker" tally for Indiana at 40,951...only 374 more than the number reported above.

That 40,951 is 15% of the combined total number of new Medicaid enrollments for Indiana from both the HC.gov website as well as through traditional state Medicaid agency offices (273,005).

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.
  • Don't be surprised if Peter Lee of CoveredCA decides to steal some thunder by announcing that California has enrolled 1,000,000 QHPs all by itself either today or tomorrow. However, that would include the past 10 days, while the HHS number will only run thru 3/01.
  • 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!

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