Louisiana

As my regular readers know, I've been a strong proponent of encouraging states to pass laws locking in as many ACA "blue leg" protections as possible in the event that the ACA itself is actually struck down by the idiotic #TexasFoldEm lawsuit (again: the ruling by the 5th Circuit Court of Appeals is due to drop at any time).

However, I've also tried to make it clear that there would be a trade-off involved: If you're going to lock in all of those "Blue Leg" protections (Guaranteed Issue, Community Rating, Essential Health Benefits, No Annual/Lifetime Caps, etc), that will mean that the premiums/deductibles will be higher than they are without those protections.

This is precisely why so-called "short-term, limited duration" policies (aka #ShortAssPlans) and other non-ACA compliant policies cost so much less at the front end...they cherry pick their enrollees and don't cover the more expensive treatments many people require.

Personally, I still think states should lock in those protections anyway, since there's only two ways this can play out:

There's only 3 states which are looking at double-digit average unsubsidized premium increases on the 2020 ACA individual market: Indiana, Vermont and Louisiana.

There's actually only 3 carriers offering individual market plans in Louisiana, but there's seven listings because two of the carriers have broken out their submissions into several different product lines. Overall, HMO LA, LA Health Service & Indemnity (Blue Cross Blue Shield of LA) and Vantage Health Plan are requesting average premium increases of 11.7% statewide.

As far as I can tell, state regulators pretty much approved all of the requested rate filings exactly as-is...the weighted average is virtually the same as it was a few months ago with the preliminary requests.

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:

Huh. This is interesting...after a couple dozen states with near-flat or even reduced 2020 premiums, Louisiana is just the third state I've come across where the carriers are seeking double-digit rate increases for next year.

There's actually only 3 carriers offering individual market plans in Louisiana, but there's seven listings because two of the carriers have broken out their submissions into several different product lines. Overall, HMO LA, LA Health Service & Indemnity (Blue Cross Blue Shield of LA) and Vantage Health Plan are requesting average premium increases of 11.7% statewide.

I should note that there's also one odd listing (see second screenshot below), from UnitedHealthcare. It claims to be for off-exchange ACA-compliant individual market plans, but two things about it make no sense:

A couple of weeks ago I noted that Louisiana Governor John Bel Edwards, a Democratic governor in a pretty red state, was trying to take whatever measures he could to provide ACA protections at the state level in case the insane federal "Texas Fold'em" lawsuit against the ACA ends up tearing down the entire law:

On Tuesday, May 21, Governor John Bel Edwards issued an executive order launching the Protecting Health Coverage in Louisiana Task Force after efforts to have protections offered to Louisianans with preexisting conditions repealed.

With the idiotic #TexasFoldEm lawsuit scheduled for oral arguments by the 5th Circuit Court of Appeals this summer, many states have been scrambling to replicate ACA protections for those with pre-existing conditions at the state level, including California, Colorado, Connecticut, Hawaii, Maryland, Nevada, New Mexico and more.

In a red state like Louisiana, unfortunately, it's not so easy...the state has a Democratic Governor, but both the state House and Senate are solidly controlled by Republicans. In addition, the Governor, John Bel Edwards, is up for re-election this November, making everything politicized, thus making it likely impossible to get anything useful through this year. Still, Gov. Edwards is trying to do something to mitigate the problem:

There was practically no change whatsoever between the rate changes requested by Louisiana carriers for the 2019 ACA individual market and the rates approved by the state insurance regulators. However, it's still good to be able to lock in the official rates just ahead of the Open Enrollment Period itself, including the individual filing data.

Overall, unsubsidized premiums should drop around 6.5%, which is good news...except that, once again, if it weren't for the ACA's individual mandate being repealed and #ShortAssPlans being expanded by the Trump Administration, I estimate they'd be dropping by another 9.3%, give or take, for a total premium reduction of more like 15.8% on average.

At $649/month full-price on average this year, that means the average unsubsidized enrollee will be paying somewhere around $724 more apiece next year due to those factors.

Only limited portions of Louisiana's actual rate filings are actually publicly available at either the SERFF database or the HC.gov Rate Review site, making it difficult to get a bead on the weighted averages. Fortunately, this article in The Advocate does the work for me:

Obamacare premiums to drop in Louisiana in 2019 after years of rate hikes

After seeing years of rate hikes, Louisiana residents getting health insurance through the Affordable Care Act’s individual exchange will see premiums drop in 2019 by an average of 6.4 percent.

The direction is an abrupt turnaround for the individual exchange, created under the ACA —commonly known as Obamacare — to offer insurance to people who don’t receive it through their jobs or other means. Until now, Louisiana’s individual market has weathered years of rising premiums, including a jump of 18.5 percent on average for 2018.

Well this could suck. The Times-Picayune reports that up to 60,000 Louisiana residents enrolled in traditional (ie, non-expansion) Medicaid might end up being kicked off the program starting in July:

Louisiana officials will have to notify around 60,000 people who are elderly or disabled in early May that they are slated to lose their Medicaid benefits in July as a result of the Legislature's stalemate over the state budget and taxes.

Gov. John Bel Edwards has proposed eliminating some Medicaid programs that provide long-term care in order to cope with a $994 million budget deficit. The governor said he doesn't want to put forward such cuts, but he doesn't have much of a choice given the state's financial restrictions starting July 1, when the new budget year begins. 

The Louisiana Department of Health is legally obligated to warn people about what might cuts be coming in July two months ahead of time, even if the programs are ultimately spared. 

With the big news this week about CMS giving work requirements the green light and Kentucky immediately jumping all over it, I decided to look up a few data points from some expansion states which don't include a work requirement for the heck of it:

MICHIGAN:

  • As of January 8th, 2018, Michigan had 669,362 adults enrolled in the "Healthy Michigan" program (aka, ACA Medicaid expansion), or over 6.7% of the total population.
  • Men make up slightly more enrollees than women (51% to 49%)
  • Enrollees are spread fairly evenly by age brackets (19-24, 25-34, 35-44, 45-54 and 55-64)
  • Around 80% of MI expansion enrollees earn less than 100% of the federal poverty line; the other 20% earn between 100-138% FPL.

LOUISIANA:

  • As of January 8th, 2018, Louisiana had 457,178 adults enrolled in Medicaid expansion (nearly 9.8% of the population)
  • Women make up 62% of enrollees

As of December 4, 2017...

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