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:
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.
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.
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which holds over 50% of the individual marketshare, clarifies that the combination of the individual mandate being repealed and the expansion of #ShortAssPlans are causing an 11% increase.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 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.
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
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.
