Kansas

NOTE: This is an updated version of a post from a couple of months ago. Since then, there's been a MASSIVELY important development: The passage of the American Rescue Plan, which includes a dramatic upgrade in ACA subsidies for not only the millions of people already receiving them, but for millions more who didn't previously qualify for financial assistance.

Much has been written by myself and others (especially the Kaiser Family Foundation) about the fact that millions of uninsured Americans are eligible for ZERO PREMIUM Bronze ACA healthcare policies.

I say "Zero Premium" instead of "Free" because there's still deductibles and co-pays involved, although all ACA plans also include a long list of free preventative services from physicals and blood screenings to mammograms and immunizations with no deductible or co-pay involved.

Once again, I'm afraid the actuarial memos for Kansas' 2021 individual and small group market carriers are either absent or redacted, so I have to run unweighted average rate changes, which are likely off significantly (for instance, the individual market is +7.8% unweighted, but if it turns out that, say, Oscar Insurance has 95% of the market share, the weighted average would be more like a 7% decrease).

Unfortuantely, without knowing the actual enrollment data for each carrier, this is the best I can do for now. The small group market's unweighted average increase is 8.2%.

Even as I'm typing this, Democratic (!) Kansas Governor Laura Kelly and Republican legislative leaders are holding a press conference to announce an agreement to finally expand Medicaid under the ACA:

TOPEKA, Kan. (KWCH) Gov. Laura Kelly and Republican leadership announce an agreement on Medicaid expansion in Kansas.

During a press conference on Thursday, the governor said the program would be funded by the hospital administrative fee. At this time, it's unknown if that fee would be passed on to patients.

Kelly said the hospitals have endorsed the program.

Kansas Senate GOP Majority Leader Jim Denning said the bill would be pre-filed on Thursday with 22 co-sponsors.

If passed in the Kansas Senate and House, the full expansion would go into effect no later than Jan. 1.

(Obviously that's January 1st of 2021 at this point, of course)

Here's some live tweeting of the event by a Kansas-based political reporter:

I didn't have the actual enrollment data for the individual carriers when I ran the numbers for Kansas in August, so I had to go with an unweighted average unsubsidized 2020 premium rate change. At the time, that came in at a 3.1% reduction.

Since then, I've dug up the hard enrollment numbers, and just this morning CMS finally posted the final, approved 2020 rate changes. The weighted average comes in at a slight increase o 0.3% statewide:

via Becker's Hospital Review:

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.

via Bruce Japsen of Forbes:

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:

(sigh) Kansas is yet another state where the enrollment data for each of the carriers is redacted on the filing forms this year. To run the weighted average, I'm using last year's estimated enrollment numbers for each, which may have shifted around this year.

Assuming things haven't shfited around too much, unsubsidized Kansans will likely be looking at roughly a 3.1% average premium reduction in 2020...which also happens to be the same as the unweighted average change.

Meanwhile, the small group market is looking at an unweighted average increase of 9.7% statewide.

(sigh) I wrote about "Farm Bureau Plans" several times last year. They've been widespread in Tennessee for a long time, and are a big part of the reason for the state's high ACA premiums (TN doesn't have the highest premiums, but they're definitely near the top of the list). Here's the description of typical Tennessee "Farm Bureau" plans:

Traditional plans require medical underwriting that may affect eligibility and rates. Medical information will be requested for any person over the age of 40 and children 25 months and under; medical records may also be requested if any health condition on the application is marked “yes.” Any fees for obtaining medical information will be at the applicant’s expense.

Underwriting guidelines regarding particular conditions may necessitate a benefit exclusion rider, a member exclusion rider or an adjusted rate for coverage. There will be a 6-month or 12-month waiting period for pre-existing conditions, depending upon the plan chosen.

Nearly two years ago, normally deep red Kansas came within a whisker of pulling off the impossible:

Kansas House fails to override Brownback Medicaid expansion veto

The effort to expand Medicaid in Kansas fell apart Monday as the House failed to override Gov. Sam Brownback’s veto of a bill that would have expanded the health care program to thousands of low-income people in the state.

The 81-44 vote, three shy of the 84 needed to overcome the governor’s opposition, effectively ends the Medicaid expansion push in Kansas after it successfully passed both chambers with bipartisan support earlier this year.

That was then. This is now. Kansas now has a Democratic governor who supports Medicaid expansion, and yesterday this happened (via Jim McLean of the Kansas News Service):

I analysed Kansas' 2019 ACA indy market rate changes back in August. The three carriers were requesting an average increase of around 6.1% (this may be slightly off since I had to estimate the market share for two of the three). State insurance regulators left Blue Cross Blue Shield and Ambetter's rate requests as is, but cut Medica's down by more than half, from a 10.7% increase to just 4.3%:

Premium Rates for Individual and Small Group Markets Individual plan premium rates may vary by age, rating area, family composition and tobacco usage. For example, a person living in Manhattan, KS (rating area 3) may pay a different rate than someone living in Pittsburg, KS (rating area 7) based on the claims data by rating area. A map of the counties included in each rating area is provided on the next page. Kansas is an effective rate review state, which means the actuarial review is conducted by the Kansas Insurance Department. KHIIS (Kansas Health Insurance Information System) claims data is utilized during the rate review process to verify the claims experience submitted by the companies. The following table provides details regarding the average requested rate revisions for companies writing individual policies in Kansas. Rate increases will be partially offset for individuals receiving a premium tax credit.

Kansas is pretty frustrating. There's only three carriers offering ACA individual market policies, but two of the three have heavily redacted actuarial memos, so I don't know what their market share is...and the same two were new (or "semi-new") to the exchange this year so I can't even use last year's effectuated enrollment as a guideline. In light of that, I had to split the estimate right down the middle to get an estimated overall market share.

In addition, Medica is the only one of the three to specifally mention mandate repeal and/or #ShortAssPlans as a contributing factor; that's also redacted in the filings for the other two. Therefore, instead of assuming 2/3 of the Urban Institute's sabotage projection, I'm being extra-cautious and assuming just half (9.6% instead of 19.2%). This gives a rough statewide average increase of around 6.1%, which would likely be closer to a 3.5% premium reduction without mandate repeal and short-term plan expansion.

I've trashed CMS Administrator Seema Verma many times for her callous and backward-logic driven push to impose pointless, counterproductive work requirements on ACA Medicaid expansion enrollees. However, it appears that even she has her limits when it comes to treating people terribly:

The Trump administration has drawn a red line on Medicaid cuts. There are some proposals that the Centers for Medicare and Medicaid Services won’t approve.

In a letter on Monday, CMS Administrator Seema Verma told Kansas officials that her agency would not approve the state’s request to impose lifetime limits, which would have capped a person’s eligibility at three years, after which they could no longer be covered by the program.

Verma noted that the administration had approved proposals by other states to cut off benefits for Medicaid enrollees only if they fail to meet certain work requirements.

I was a bit confused by the initial rate hike request for individual market carriers in Kansas, but it seems I was overthinking it. There will be three carriers offering indy market plans this year: Medica, Blue Cross Blue Shield of Kansas and Ambetter (aka Centene, but operating under the name "Sunflower State" here, which is just annoying).

Ambetter ("Sunflower State") is new to the state, so there's no "rate hikes" to speak of. My confusion was regarding BCBSKS, which is already on the KS exchange but didn't appear to submit any actual "rate change" request last time I checked. Louise Norris has cleared up this mystery:

Until recently, my 2018 Rate Hike project was still missing 4 states: Kansas, Missouri, Nevada and Utah. Last week Missouri finally posted their requested rate increases for next year. Today it looks like Kansas has done the same...at least partly.

As I noted back in June, there are 3 carrers on the KS individual market this year: Medica, Blue Cross Blue Shield of Kansas Solutions and Blue Cross Blue Shield of Kansas City. Any confusion between the BCBS names was made moot, however, as BCBS of KC announced they were dropping out of the indy market anyway.

That leaves Medica and BCBSKS, both of whom filed plans to stay on the market...but only Medica appears to have actually submitted rate requests, for a mere 7,600 enrollees:

Between updating the "Who could lose coverage" graphics, prepping for my town hall thing last night and updating the 2018 Rate Hike project, I've gotten way behind on my "Who's saying 'screw rate hikes, I'm just gonna bail completely next year' updates. Let's take care of that now, OK? The first three updates are courtesy of Louise Norris writing for healthinsurance.org; the fourth is vai Kimberly Leonard for the Washington Examiner:

IDAHO: BridgeSpan is out, 4 carriers staying put:

Insurers in Idaho had to submit forms for 2018 plans by May 15, but they have until June 2 to file rates. Mountain Health CO-OP, SelectHealth, PacificSource and Blue Cross of Idaho all filed forms to continue to offer Your Health Idaho plans in 2018.

As I noted when I crunched the numbers for Texas, it's actually easier to figure out how many people would lose coverage if the ACA is repealed in non-expansion states because you can't rip away healthcare coverage from someone who you never provided it to in the first place.

My standard methodology applies:

I originally looked at the requested rate hikes in Kansas back in June; at the time, the weighted statewide average was roughly 35%.

While I haven't seen any press releases or news stories about it, when I looked at HealthCare.Gov's rate review database this morning, I saw that they have fianl (approved) rate increases listed for all of the Kansas listings. In most cases the requests were approved as is; in Coventry's off-exchange plans, however, are being increased more than requested, giving the following.

I should also note that according to Louise Norris, Medica is also entering the Kansas exchange for the first time, which means there's no "increase" to list since there's no current rates to compare them to.

The good news about Kansas is that 5 of the 6 carriers which have submitted 2017 individual market rate filings included their current enrollment totals in a clear, easy to see format...and the 6th one is (once again) "Freedom Life" which, judging by the dozen other states they've popped up in, almost certainly has only 1 or 2 enrollees (or none at all) anyway.

The bad news is...well, the requested rate hikes are pretty ugly: About 35.3% on weighted average.

Also, is it really necessary for Blue Cross Blue Shield to operate under three nearly-identical names? Really?

Thanks to JJGomez127 for the heads up:

Kansas health insurance marketplace may gain company offerings for 2017

TOPEKA, KS — Ken Selzer, CPA, Kansas Commissioner of Insurance, said today that Kansas health insurance consumers may have additional company options for coverage in the federallyrun marketplace for 2017.

“Health insurance options filed now for the individual market show that competition will likely continue for Kansans’ health insurance policies,” Commissioner Selzer said.

Filings with the Kansas Insurance Department as of May 2 show two additional carriers may participate in the marketplace. Medica, a non-profit, Minnesota-based company, and Coventry Health and Life are companies that have filed for the 2017 open enrollment period.

Medica Insurance Company is set to offer a number of plans, and Coventry is proposing Exclusive Provider Organization (EPO) Network plans. Both companies have filed to offer plans off the federally-facilitated marketplace as well.

When UnitedHealthcare announced last month that they were making good on their threat last fall to pull out of the individual market in over two dozen states next year, it caused shockwaves across the health insurance industry. It is an important development, as around 800,000 people will be impacted.

When Humana announced last week that they plan on pulling out of the individual market in at least 5 states next year, it was interesting and a bit of a bummer, but not nearly as earthshattering, because only about 25,000 people will have to shop around and find a new carrier.

Today, it is my duty to announce that Celtic insurance has also decided to pull out of the entire individual insurance market (both on and off-exchange) across at least 6 states, including:

This is really just a summary of my last 4 posts. I've combed through the SERFF databases for every state which uses the system for rate filings, and while very few have the actual 2017 rate filing requests listed yet, at least 4 of them have official individual market exit letters submitted for 2017 from Jane Rouse, the Product Compliance Process Owner for Humana Insurance Co:

This list may grow as additional state filing data and/or press releases come out from Humana, but assuming these are the only 4 states Humana is bailing on, the news isn't quite as bad as it appears at first.

To keep things in perspective, add the 4 numbers above up and it's 25,512 people across 4 states with a combined population of 21.8 million. Put another way, these 25.5K people represent only 2.9% of the 875,700 people Humana currently has enrolled in individual policies (both on & off exchange) nationally.

To be clear, I'm not saying this is a good development; when you combine it with the recent UnitedHealthcare Dropout Odometer it's more of a drip-drip-drip sort of thing. But it isn't disasterous for the exchanges either (at least not yet).

UPDATE: I've been informed by a reliable source that Humana is also dropping out of the individual market in Nevada next year, although I don't have any actual enrollment data there. Humana is not currently participating on the Nevada exchange, however, so any dropped enrollments would be OFF-exchange only. In fact, I'm pretty sure that the only individual market enrollees Humana has in Nevada are grandfathered policies anyway, so the numbers should be pretty nominal there.

Yep, sure enough, Humana is following UnitedHealthcare out the door of multiple states next year. That's 1,800 people impacted, although they're all OFF-exchange only:

OK, the bad news is that the requested 2016 individual market rate increases in Kansas were somewhere around 28%, with some as high as 38%. This would have looked something like this:

Ouch. The good news (well...relatively good, anyway), is that in the end, the approved rate hikes are considerably less...although still not pretty:

Premiums for Kansas health insurance plans offered in the federal marketplace won’t increase as much as originally proposed, state Insurance Commissioner Ken Selzer said Tuesday.

Kansas Insurance Commissioner Ken Selzer said Tuesday that premiums for health insurance plans offered in the federal marketplace won’t increase as much as originally proposed.

Hmmm...the headline looks bad, but when you read further it's clearly a matter of perspective more than anything else:

Maryland's health insurance exchange improperly billed the federal government $28.4 million, a Department of Health and Human Services audit reported Friday.

An inspector general's probe found a lack of oversight and internal controls, not criminal wrongdoing, was the cause of the exchange's problems since the marketplace opened in 2013.

I have a ton of ACA-related stories cluttering up my in-box again; here's some of the more interesting ones, all regarding ACA Medicaid Expansion:

MICHIGAN:

For months now, I've been a bit obsessed with figuring out how my home state's Medicaid expansion enrollment has managed to reach as high as 21% more people than were supposedly even eligible for the program. Estimates last year ranged from 477,000 - 500,000, yet enrollment in Healthy Michigan (Gov. Snyder's name for Obamacare Medicaid Expansion) currently sits at a whopping 579K, less than 1 year into the program.

Presented without comment:

How Brownback Is Relying On O-Care To Close Kansas' Huge Budget Hole

Kansas Gov. Sam Brownback (R) is calling all hands on deck to fix his state's huge self-imposed budget crisis, which nearly cost him re-election this year, and the staunch conservative is now receiving an assist from an unlikely source: Obamacare.

The state's well-documented budget troubles came after Brownback's dramatic reductions in taxes since taking office in 2011. With its revenue drying up and cash reserves depleted, Kansas is staring at a $280 million hole in its $6.4 billion FY 2015 budget, which ends in June.

Brownback offered his proposal for closing that hole last week, a mixture of spending cuts and transferring funds from other parts of the budget to fill it. And second biggest of those transfers is $55 million in revenue from a Medicaid drug rebate program that was bolstered under the Affordable Care Act.

The short version then is this: Obamacare is helping Kansas address its fiscal crisis -- even if Brownback's administration seems loath to admit it.

I'm kicking myself for not writing up a full post on this issue, since it's the issue which most directly connects today's election to ACASignups-specific issues, but thankfully, Sam Stein and Jeffrey Young have done a fantastic job anyway. The key takeaway is this:

There are two threads of conventional wisdom heading into Tuesday's midterm election. The first is that the election doesn't much matter. Regardless which party controls the Senate, President Barack Obama will still occupy the White House, which means gridlock will remain, if not escalate. The second is that, when it comes to Obamacare, the status quo will remain in place for at least the next two years. Senate Republicans may push for repeal votes. But Obama will veto them. Smaller reforms may pass. But the law will mostly remain intact.

Me, October 1st:

Kansas: Shocker: Pat Roberts lying about number of policies cancelled

In Kansas, yes, insurance companies were allowed to bump out non-compliant plans by at least a year...and indeed, Blue Cross Blue Shield of Kansas ended up not cancelling "between 9,500 - 10,000" of their policy holders after all.

So...that basically wipes out half of the "20K cancelled" claim already.

...Supposedly Aetna/Coventry and some smaller providers may have originally been planning on cancelling a bunch of plans as well...except that according to this article, Coventry never got around to doing so in the first place...

...That pretty much leaves BCBS KC and the other 10K. Based on the evidence at hand, my guess is that they likely reversed their cancellation decision as well...and if they did, that means that the actual number of Kansans who lost their healthcare policy in 2013 due to ACA noncompliance may have actually been as little as...ZERO.

Republican U.S. Senator Pat Roberts is scrambling for his political life after the Kansas Democratic Party pulled off a clever maneuver by deliberately dropping out of the race in order to shore up support for independent challenger Greg Orman (who may or may not caucus with the Dems, but would still be a huge step up from Roberts).

Anyway, Roberts has gone on the attack against Orman with a rather lame attack ad trying to paint Orman as an Obama/Pelosi/Ultra-Leftie Liberal, bla bla bla.

Aside from general Obamacare bashing, the ad makes one interesting claim: That "20,000 Kansans lost their healthcare because of" the ACA. The headline accompanying the narration reads "Obamacare cancels almost 20,000 Kansas health care plans" and cites "Kansas Watchdog" from 10/31/13 as the source:

Yesterday, the Big News on the ACA front was a new state-by-state survey from Gallup which showed the overall impact to date on total uninsured rates across the country.

Not surprisingly, the main takeaway, as noted by Jeffrey Young over at the Huffington Post, is that states which have embraced the law (Medicaid expansion, their own exchanges) have done a much better job overall of reducing their uninsured numbers than those which shunned it.

It's an interesting survey and an interesting piece, complete with a color-coded map which shows how the different states have fared (although I really wish they'd used higher-contrast colors; it's hard for me to distinguish some of the ranges from others).

However, there's one state which really stands out to me, and it's smack in the center: Kansas.

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