I've mentioned tomorrow's Kentucky gubernatorial election, and the fact that Republican candidate Matt Bevin is not just a staunch opponent of the ACA (not exactly a shocker) but that he's repeatedly stated that if elected, he'd repeal the state's implementation of Medicaid expansion, which is currently providing healthcare coverage for about 400,000 people (around 350K enrolled in 2014, and another 50K or so this year).

However, I was a bit shocked this morning when I realized that I've only mentioned the KY race in passing via my "Short Cuts" link roundups.

With the election just one day away and my plate filled with other OE3-related stuff, I don't really have time to do a full write-up. Fortunately, John Oliver of Last Week Tonight has done an excellent job of explaining the whole situation (there's actually three state elections tomorrow where Medicaid expansion is theoretically an issue, but Kentucky is the only one where it's at risk of being taken away). Watch the whole thing:

Thanks to Zachary Tracer for the heads up.

The other day I wrote a general overview of the ACA "Risk Corridor" debacle.

The short version is that there were 3 funding programs put in place under the Affordable Care Act designed specifically to help smooth the waters and keep insurance carriers afloat for the first few years until they got past the bumpy transition period. One of these was called the "Risk Corridor" program. Basically, the carriers who lose their shirts the first 3 years were supposed to have at least a portion of their losses covered to tide them over; call it "training wheels" for the insurance industry. The funding was supposed to come partially from the other insurance companies which did better than expected...but any shortfall was supposed to be covered by the federal government, with the caveat that any surplus paid to the government stayed there as a type of profit.

A couple of days ago I noted that Covered California is adding a very good feature this year: They're opening up 2016 enrollment nearly 3 weeks early...for those who are already currently enrolled. Starting this monday, Oct. 12, current enrollees will be able to renew or switch to a different CoveredCA plan, 19 days ahead of he official Nov. 1st Open Enrollment launch.

Today I discovered that at least one other state-based exchange (Kynect, in Kentucky) is doing this as well...sort of:

I clicked through and saw this listed under the Frequently Asked Questions:

1. How do I enroll in kynect?
Simply visit or talk to your insurance agent. If your insurance plan is up for renewal, you may be eligible to enroll through kynect today. You can also call Customer Service at 1-855-4kynect (459-6328).

I was kind of hoping that this morning's Gallup uninsured rate news would include a monthly update for July; instead, it only runs through the end of June, the same quarterly survey results that they released a month ago. Then again, things probably didn't change much in July.

Instead, this time they've broken the numbers out by state:

WASHINGTON, D.C. -- Arkansas and Kentucky continue to have the sharpest reductions in their uninsured rates since the healthcare law took effect at the beginning of 2014. Oregon, Rhode Island and Washington join them as states that have at least a 10-percentage-point reduction in uninsured rates.

IMPORTANT: See this detailed explanation of how I've come up with the following estimated maximum approved weighted average rate increases for Kentucky.

A few weeks ago, I wrote about the Kentucky individual market rate increases. Kentucky was the 2nd state to announce the approved rate hikes...although there's a frustratingly large number of "N/A" entries for some pretty big companies (Aetna, UHC, etc).

Fortunately, as I explain in the first link above, I've still been able to piece together rough estimates of the maximum possible and most likely approved average rate increase for the Kentucky individual market:

This AP article provides snippets about a handful of states; it'd be nice if they just released the actual report so we could see the hard expansion numbers (as opposed to the total increase numbers, which are still obviously useful but don't distinguish between traditional Medicaid and ACA expansion enrollees):

In Kentucky, for example, enrollments during the 2014 fiscal year were more than double the number projected, with almost 311,000 newly eligible residents signing up. That's greater than what was initially predicted through 2021. 

...At least 14 states have seen new enrollments exceed their original projections, causing at least seven to increase their cost estimates for 2017, according to an Associated Press analysis of state budget projections, Medicaid enrollments and cost details in the expansion states. A few states said they could not provide original projections.

Last week Oregon became the first state to actually approve their 2016 individual/family and small group market policy rate changes. Yesterday, Kentucky appears to have become the second:

Unfortunately, as you can see, while the average rate request for each company is listed, it isn't easy to find the actual enrollment/market share data for most of them, making it impossible to get a weighted average. In addition, there's an awful lot of "n/a / 0%" entries for some pretty big companies. Usually this means that they're new to the market, but I'm not sure that's the case here.

Anyway, assuming that I have the partial data above accurate, it looks like Kentucky's individual market changes will range from an 11% decrease (for WellCare Health Plans of Kentucky, Inc.) to a wince-inducing 25% increase (for the Kentucky Health CO-OP). I don't know how many are enrolled in WellCare right now, but the CO-OP has 53,000 customers, so expect some shuffling around...except, again, I have no idea what that's a 25.1% increase from.

Now that the King v. Burwell Supreme Court oral arguments are out of the way (with radio silence expected until they announce the decision sometime in June) , the next Big Development to keep an eye on ACA-wise is...Tax Season! There will be plenty of stories about how many people have to pay back some/all of their 2014 tax credits, how many will receive additional tax credits...and, most germane to this site, how many additional people enroll via the exchanges to avoid having to pay (most) of the higher tax penalty next year for not being covered in 2015 during the Tax Filing Season Special Enrollment Period (SEP), or #ACATaxTime as I prefer to call it.

This Just In from Maryland...


Special Enrollment Period will run March 15 through April 30

BALTIMORE (Feb. 25, 2015) — Maryland Health Connection is allowing consumers who owe a tax penalty for not having health coverage in 2014 to still enroll for 2015 coverage through a special enrollment period that will run March 15 through April 30.

Consumers who owe or have paid a tax penalty for not having coverage in 2014 would pay a higher penalty for this year if they also did not enroll for 2015. The open enrollment period to buy a Qualified Health Plan for 2015 ended Feb. 15.

The special enrollment period is for Marylanders who must pay the penalty for lacking health insurance in 2014 and who attest that they became aware of the penalty during this income tax filing season after the Feb. 15 close of open enrollment for 2015 coverage.

OK, you can scratch Kentucky off the list; this leaves just 2 states left (Connecticut and Idaho) which haven't provided enrollment data thorugh the official 2/15 deadline:

2014/2015 Open Enrollment stats as of Thursday 2/19/2015:

Kentucky's Kynect Facebook page, last night:

Open enrollment with kynect ended this past weekend on February 15, 2015. If Kentuckians make a good faith effort to complete their enrollments with kynect prior to the February 15, 2015 deadline but were unable to do so due to technical difficulties with the application process or problems reaching the call center, we will work with applicants to secure that coverage through February 28, 2015.

Please contact the call center at 1-855-4kynect and ask to be transferred to the Kentucky Health Benefit Exchange (KHBE) Tier II staff for assistance with these applications.

Kentucky was the last state to announce some sort of of "In Line by Midnight"/Overtime extension period.

I actually wasn't expecting any further enrollment updates today, but Kentucky has slipped in one more before the final weekend:

To date 150,665 Kentuckians have enrolled in healthcare coverage through #kynect for 2015. Open enrollment ends Feb. 15 at midnight. #ACA

— kynectky (@kynectky) February 13, 2015

Of the 150,665 enrolled > 75,760 renewed enrollments from last year > 23,274 are newly enrolled in private plans > and 51,631 are Medicaid.

— kynectky (@kynectky) February 13, 2015

Here's how KY has ramped up in recent weeks:

  • 1/22: 92,886 QHPs
  • 2/05: 95,927 QHPs (217/day)
  • 2/12: 99,034 QHPs (444/day)

That's more than a 2x enrollment rate increase from last week.

Kentucky's previous update had them at 92,886 QHPs and 38,547 additional Medicaid enrollees via kynect, as of 1/22.

Today's update brings these numbers up to 95,927 QHPs and 46,422 added to Medicaid, increases of 3,041 and 7,875 respectively (through yesterday).

That's 217/day on the private side, during a the slow patch. In order to reach the HHS target of 107K QHP selections, they'll have to average 1,100 per day. With the expected deadline surge, this will be tough but doable. Reaching my KY target of 130K, on the other hand, would need 3,400/day, which doesn't seem to be in the cards.

2014/2015 Open Enrollment stats as of Thursday 2/5/2015:

Hot off the presses...

As of Jan. 22 @ 3:30: 75,760 individuals have renewed QHP enrollments > 17,126 are newly enrolled in QHPs > and 38,547 are Medicaid. #kynect

— kynectky (@kynectky) January 23, 2015

OK, that's 92,886 QHPs total, or 208/day since the December 15th deadline. At that rate, they'll likely add a minimum of 5,000 more by 2/15 if there's no mid-February surge; more likely they'll add between 10-15K more, for a total of perhaps 108K at the outside, just barely hitting the HHS Dept's target (107K), but coming up short of mine (130K)...but we'll have to see...

Hmmm...kynect (Kentucky's ACA exchange) reported 88,289 QHP enrollees (renewals + new) as of January 6th. Just now they tweeted...

In the last week alone, #kynect has newly enrolled 3,141 individuals in one of the qualified health plans offered through the KY exchange.

— kynectky (@kynectky) January 16, 2015

So, that brings their total up to 91,430 as, "the last week alone" suggests 7 days, which would mean either 1/07 - 1/13 or 1/09 - 1/15 (which would leave a 2-day gap). Fortunately, they then followed up with this:

Two months of open enrollment down & more than 125,000 Kentuckians have newly enrolled 4 health coverage or renewed their plans thru #kynect

— kynectky (@kynectky) January 16, 2015