2020 OPEN ENROLLMENT ENDS (most states)

Time: D H M S

Iowa

When I ran the numbers for Iowa's preliminary avg. 2020 unsubsidized individual market rate changes, I had to use an unweighted average reduction of around 3.3%. However, knowing the relative market share of each carrier can make a big difference.

Case in point: It turns out that Medica holds something like 97% of Iowa's ACA-compliant market...whcih means the 11.3% rate drop by Medica heavily weighs the overall average. Wellmark is raising their rates by about 4.7%, but that only nudges the statewide weighted average to a 10.8% reduction overall.

(SIGH) OK, apparently the Kaiser Family Foundation has been working on the same project as I have for the past couple of weeks, so most of this is no longer "exclusive". HOWEVER, I have additional details including individual carrier breakouts and projections for potential 2019 rebates, so there's that...

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.

(sigh) As is common this year, the rate filings for Iowa's Individual and Small Group market are heavily redacted, making it impossible to calculate a weighted average premium rate change. On the Indy market, Medica is reducing their unsubsidized 2020 premiums by 11.3%, while Wellmark is raising theirs by around 4.8%.

Seeing how Wellmark only re-entered the ACA-compliant individual market this year, I'm assuming Medica has the lion's share of enrollees...but who knows? Also, Wellmark is offering two different types of policies; I'm assuming that at most the two combine to be similar to Medica's total. If so, that should mean an average premium reduction of around 3.3%.

For the small group market, I just ran an unweighted average of the 12 different companies offering policies, coming up woth an average 5.4% increase.

There is one interesting tidbit in the Wellmark filing, however: They expect 100% of their 2020 enrollees to do so on-exchange, which basically means that their unsubsidized premiums have gone up so much that they don't expect anyone to be willing to pay full price (off-exchange) for them.

 

I've included the transcript below, but words can't accurately describe the tone of voice or the body language of Grassley in the actual video, so I'll just urge everyone to watch it.

WOMAN: "What is your plan to keep millions of Americans like myself covered? Those of us with pre-existing conditions, people who are on their parents insurance, and again, people like myself who need life-guaranteeing medication? We could lose our insurance and I'd probably be dead in 2 months."

GRASSLEY: "Well, there's a...there's a lot of, uh...and she's asking only because the courts may declare [the ACA] unconstitutional. Now, I don't think that the courts are going to declare it unconstitutional..."

WOMAN: "You voted seven times to repeal it."

GRASSLEY: (pause) "Yes."

WOMAN: "Why? What are you going to do for people on the ACA?"

Combined, the Medicaid and CHIP programs have around 72.5 million Americans enrolled in them as of December 2018. However, the vast majority--over 80% of them--are actually enrolled in privately managed Medicaid programs. Managed Care Organizations (MCOs) are private health insurance companies which states contract with to handle the administration and management. In some cases this works out reasonably well. In others...not so much:

UnitedHealthcare is pulling out of Iowa's private Medicaid management program

More than 425,000 poor or disabled Iowans will soon have to switch health insurance carriers. 

UnitedHealthcare, which manages health care for more than two-thirds of Iowans on Medicaid, is leaving the market, Gov. Kim Reynolds’ office announced late Friday afternoon.

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:

Last week I noted that New Mexico had capped off a flurry of positive healthcare policy legislation by passing a bill (in dramatic fashion) which would lock in ACA-level protections for those with pre-existing conditions in the event the ACA itself is ever repealed or weakened.

Once this bill is signed by the Governor (which is almost certain to happen), New Mexico will join four other states (Massachusetts, New York, Colorado and Virginia) in fully protecting all three types of "blue leg" protections: Guaranteed Issue, Community Rating and Essential Health Benefits. The New Mexico bill also locks in a fourth ACA protection: The prohibition on annual or lifetime coverage limits.

As I noted a few weeks ago, I haven't written a whole lot about the idiotic (but terrifyingly so) TexasFoldEm lawsuit in awhile. Part of this is because I was out of the country over the holidays; part is because there hasn't been a whole lot of movement on the case since right-wing federal Judge Reed O'Connor ruled that the ACA was unconstitutional using a legal argument so thin it hula hoops with a Cheerio.

Anyway, when I last checked in, a coalition of Attorneys General from 16 states (plus the District of Columbia) had formally filed to appeal Judge O'Connor's ruling, and the U.S. House of Representatives had also formally voted to intervene on behalf of defending the ACA from the lawsuit, which was filed last year by a coalition of 18 Republican Attorneys General, plus two Republican Governors.

I just received the following press release from the Iowa Insurance Division...

2019 Health Insurance Enrollment Deadline Approaches

Des Moines – Open enrollment begins November 1 and ends December 15 for Iowans purchasing or changing their Affordable Care Act (ACA) individual health coverage to become effective January 1, 2019.

“As the open enrollment season begins, Iowans should thoroughly research all coverage options. The ACA-compliant insurance market is available to Iowans, however, most Iowans have been priced out of that market if they are not currently receiving federal subsidies to help pay premiums and, in some instances, deductibles. I would encourage consumers to meet with a licensed insurance agent to determine the best plan for themselves and their families,” Iowa Insurance Commissioner Doug Ommen said. “Changes made at the Iowa state legislature and by the federal government have provided a few more options in addition to ACA-compliant coverage for Iowans to review as they plan out their health needs for 2019.”

Iowa has only a single insurance carrier offering ACA-compliant individual market policies this year. Next year they'll have two, as Wellmark has decided to Hokey Pokey their way back onto the exchange again in 2019...but since they weren't around this year, there's no current policy premiums to measure any increase (or decrease) against.

That leaves Medica. Here's what they had to say about their 2019 rates back in June:

Medica, the sole carrier now selling individual health insurance policies in Iowa, plans to raise its 2019 premiums by less than a tenth as much as it did for 2018.

Medica raised its Iowa health insurance premiums by a staggering average of 57 percent for 2018. It was the steepest such health insurance increase in Iowa history. Company leaders said last summer they needed the higher premiums to stay in the market. But this time around, the Minnesota-based carrier is planning to raise Iowa premiums by an average of less than 5.6 percent, state regulators disclosed Wednesday.

Last year, Iowa's already-ugly individual market was rocked further yet by Big Kahuna Wellmark announcing that after finally entering the ACA exchange market in 2017, they were dropping back out again this year, leaving Medica as the only carrier offering ACA-compliant policies throughout the whole state. In response, Medica raised their 2018 ACA rates by a whopping 57% this year. This, in turn, led to the state legislature passing a law which stripped away pretty much any type of restriction or regulation of "Farm Bureau" plans, exacerbating the risk pool problem further yet.

A couple of weeks ago, I noted that Iowa had come up with an ingenious plan to resolve their troubled individual health insurance market: Start offering junk plans for everyone and damn the consequences:

Well, sure enough, just yesterday the Iowa state Senate voted to allow unregulated junk plans to be sold to...pretty much anyone in the state:

The Iowa Senate voted Wednesday to let the Iowa Farm Bureau Federation and Wellmark Blue Cross & Blue Shield sell health insurance plans that don't comply with the federal Affordable Care Act.

The new coverage could offer relatively low premiums for young and healthy consumers, but people with pre-existing health problems could once again be charged more or denied coverage.

*(except people who are actually sick, that is) --h/t Anne Paulson

I've written a lot about Idaho's decision to simply ignore ACA regulations by allowing non-ACA compliant healthcare policies which would destabilize the individual healthcare market even worse than it already is today.

A couple of weeks ago, University of Michigan law professor and ACA expert Nicholas Bagley explained how the bigger danger here is that if this move is allowed to stand, it won't be limited to just Idaho:

But it would be a mistake to ignore what Idaho is up to. If the Trump administration doesn’t intervene, other red states will surely follow in its footsteps. The result will be widespread disregard of the law and the rise of state-to-state inequalities in the private market similar to those that already exist in Medicaid.

 

May 11, 2015:

Wellmark spurns Obamacare exchange, but two competitors don't

Moderate-income Iowans who want to use Affordable Care Act subsidies to purchase health insurance still won't be able to choose policies from Wellmark Blue Cross & Blue Shield next year. But they should be offered policies from at least two competitors.

April 25, 2016:

Iowa’s dominant health insurer has agreed to start selling policies a year from now that qualify for Obamacare subsidies.

Pages