Maine

Back in late June, I noted that the Maine Insurance Dept. had issued the preliminary 2021 rate filings for the state's individual and small group market carriers. At the time, the individual market carriers were averaging rate reductions of around 4% while the small group carriers were looking to raise premiums by around 6.2%.

It was recently brought to my attention that revised rate filings have been submitted by Maine carriers for 2021...and while these still aren't the final/approved rates, they're significantly lower than the original filings.

Two of the three indy market carriers (Anthem and Harvard Pilgrim) have reduced their rates dramatically. The third (CHO) only reduced theirs by a couple of points, but the net result is that they're now averaging a 13% reduction...9 points lower than the 4 points they were already being knocked down.

The small group market carriers didnt' change their requests by as much, but they're still lower: A 4.4% average increase instead of 6.2%.

Over at healthinsurance.org, Louise Norris has already done the work for me in tracking down the preliminary 2021 individual and small group market rate changes for the state of Maine:

Average premiums expected to decrease Maine’s exchange in 2021

Maine’s three individual market insurers filed proposed rates for 2021 in June 2020 (average proposed rate changes are summarized here by the Maine Bureau of Insurance). For the second year in a row, average rates are expected to decrease for 2021:

Maine Governor Janet Mills had already announced her intentions regarding moving Maine to a state-based ACA exchange last fall, but now she and state legislative leaders are making it official with the rollout of a new bill...but they're including several other important improvements as well, and I'm mostly cheering all of these, although the logic is a bit confusing on a couple of points:

Mills, Jackson & Gideon Announce Bill to Improve Health Insurance for Maine People and Small Businesses

Augusta, MAINE – Governor Janet Mills, Senate President Troy Jackson, and Speaker of the House Sara Gideon today announced legislation to improve private health insurance for Maine people and small businesses. LD 2007, The Made for Maine Health Coverage Act, would make some of the most common medical visits free or less costly, simplify shopping for a plan, leverage federal funds to help make premiums more affordable for small businesses, and put Maine in the driver’s seat to ensure that all Maine people have clear choices for their coverage.

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:

Some Guy, June 25, 2015 (right after the Supreme Court ruling in King vs. Burwell):

It's even conceivable--unlikely, but conceivable--that a few years from now, after 1) The ACA has become even more firmly entrenched nationally; 2) the software/technology for running a state exchange has become even more streamlined, simplified, faster, easier to use, cheaper, etc etc; and 3) (hopefully) some changed attitudes/changed administration officials (ahem), a few states on HC.gov now may even decide to go ahead and move onto their own "full" exchange/website after all...completely of their own volition.

February 2018:

Nevada wants out of federal health exchange

Nevada's Silver State Health Insurance Exchange took the first step on Thursday to getting out of the federal healthcare.gov system and build its own exchange.

Back in June I noted that Maine's Bureau of Professional & Financial Regulation released their preliminary 2020 rate filings for the Individual and Small Group markets. At the time, the three carriers on their Indy market were requesting average rate increases of around 4.7% next year.

In July I reported that the carriers themselves sliced their unsubsidized 2020 rates down of their own volition, to a 1.6% decrease on average.

Last week, after a public comment meeting, it looks like the Maine Insurance Dept. went ahead and approved the lower, revised rates for all three individual market carriers.

Last month I noted that Maine's Bureau of Professional & Financial Regulation released their preliminary 2020 rate filings for the Individual and Small Group markets. At the time, the three carriers on their Indy market were requesting average rate increases of around 4.7% next year.

Well, the final/approved rate changes won't happen for another month or so, but it looks like the carriers themselves have sliced their unsubsidized 2020 rates down of their own volition:

Maine’s three providers of individual health insurance on the Affordable Care Act marketplace have revised their rate requests for 2020, significantly lowering their projected rates.

Previously, the insurers had sought modest average rate increases of 1 percent to 8 percent. Under the revised filings, two of the three insurers are now requesting decreases for individual plans, and the other is seeking an increase of less than 1 percent.

The state of Maine's Bureau of Professional & Financial Regulation has released their preliminary 2020 rate filings for the Individual and Small Group markets. Overall, the three carriers participating in their individual market are seeking a weighted average rate increase of 4.7% vs. last year. If approved as is, that would bring the average unsubsidized premium up from $675/month to $707/month, or around $381/year.

It's important to keep in mind why premiums are going up. I've included screenshots of the rate filing memos--Maine Community Health Options, which holds over 50% of the individual marketshare, clarifies that the combination of the individual mandate being repealed and the expansion of #ShortAssPlans are causing an 11% increase. They also note that Maine's recent Medicaid expansion implementation may be a factor, although normally that reduces premiums since lower-income populations tend to be less healthy than higher-income populations, so I'm not sure what to make of that.

Governor Mills Announces Federal Approval of Medicaid Expansion

Governor Janet Mills announced today that the U.S. Centers for Medicare and Medicaid Services (CMS) has approved Maine’s State Plan Amendments to expand Medicaid (MaineCare) under the Affordable Care Act. CMS notified the Maine Department of Health and Human Services (DHHS) of the approval today.

CMS approved the state’s plan retroactive to July 2, 2018, which was the date indicated in the 2017 ballot initiative supported by nearly 60 percent of Maine voters. MaineCare expansion is projected to provide coverage to approximately 70,000 people throughout the state. With today’s approval, the federal government will finance more than $800 million in estimated costs for those who enroll under expansion from July 2, 2018 through state fiscal year 2021. Maine is among 36 states plus the District of Columbia that have expanded Medicaid.

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.

*(Yes, that's sarcasm...it's been anything BUT "just like that" in Maine...)

Openly racist and mini-Trump GOP Maine Governor Paul LePage spent the better part of the past eight years blocking the expansion of Medicaid under the Affordable Care Act. First, he vetoed the Medicaid expansion bills passed by the state legislature a whopping seven times. Then, when Maine voters finally had enough and successfully passed a statewide ballot initiative to force the issue, LePage spent another full year continuing to fight against actually implementing the expansion provision via legal challenges and flat-out violation of court orders.

Hot on the heels of Wisconsin's ACA reinsurance program being approved by CMS comes another reinsurance waiver approval, this time for Maine:

The U.S Department of Health and Human Services and the U.S. Department of the Treasury (the Departments) approved Maine’s application for a State Innovation Waiver under section 1332 of the Patient Protection and Affordable Care Act (PPACA) (the waiver). Maine’s application seeks to reinstate a reinsurance program called the Maine Guaranteed Access Reinsurance Association (MGARA) from 2019 through 2023. As a result of the waiver approval, more consumers in Maine may have coverage, consumers will see lower premiums, and the state will receive Federal funds to cover a substantial portion of state costs for MGARA.

Maine’s State Innovation Waiver under section 1332 of the PPACA is approved subject to the state accepting the specific terms and conditions (STCs). This approval is effective for January 1, 2019 through December 31, 2023.

Summary of Maine’s State Innovation Waiver under section 1332 of the PPACA Application

Shout-out to Mitchell Stein for this heads up: The Maine Bureau of Insurance has posted their preliminary 2019 individual and small group policy premium rate filings.

One important twist: A few months back I remember reading that Maine, like several other states, was considering establishing some type of reinsurance program along the lines of successful programs in Alaska, Minnesota and Oregon. I also remember reading that the Maine version was unusual--it would actually involve reestablishing an old, discontinued state program which was still on the books but had been mothballed for years. However, I never got around to doing a write-up about it.

Anyway, it looks like the program (Maine Guaranteed Access Reinsurance Association, or MGARA for short), is indeed being ramped back up:

via Alice Ollstein of Talking Points Memo:

A state court in Maine has ruled that Gov. Paul LePage (R) must submit the paperwork necessary to move forward on expanding Medicaid under the Affordable Care Act to cover about 70,000 more low-income people in the state.

In her ruling, state judge Michaela Murphy slammed LePage’s health department for unilaterally blocking the expansion’s implementation since voters overwhelmingly approved it by ballot initiative last November.

“The Court concludes that the Commissioner’s complete failure to act cannot be considered substantial compliance,” she wrote, ordering the governor to submit the necessary paperwork to the federal government by June 11.

It wasn’t immediately known whether LePage planned to appeal the decision.

PREDICTION: Yeah, he will. He's out of office in seven months, and I'm willing to bet he's gonna continue doing everything possible to drag this out until his replacement takes office in January.

As noted earlier, I've been a bit lax with posting for a few days as I've worked on my latest 2-part video explainer about risk pools and #ShortAssPlans.

However, there's been a lot going on, so I figured I should try and at least do a quick update on a few items. First up: Medicaid expansion!

Here in my home state of Michigan, I've written several posts about how the GOP-controlled state legislature trying to shove through a draconian "work requirement" bill for Healthy Michigan, our name for ACA Medicaid expansion program which has been working just fine, thank you very much, for nearly 5 years now. The bill easily passed the state Senate (where the GOP holds a supermajority), and is now under consideration by the state House (where they have a smaller but still solid majority at the moment). The good news is that GOP Governor Rick Snyder--who championed passage of Healthy Michigan in the first place and seems to think it's fine mostly the way it is--is likely to veto the senate version of the bill. The bad news is that it might simply be tweaked somewhat by the House.

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