Nebraska

With Blue Cross Blue Shield of Nebraska declining to participate in the Nebraska exchange, that leaves just Medica as the sole individual market carrier. They're asking for a 16.9% average rate hike, 

Interestingly, while Medica's rate filing letter clearly states that the 16.9% request assumes CSR payments will be made and the mandate will be enforced, they also list "unprecedented uncertainty/risk inherent in the marketplace" as one of the key drivers of the increase.

The Kaiser Family Foundation estimates the CSR issue as adding around 15% to NE Silver plans, which translates into roughly a 10% additional increase if spread across all polices, or 26.9% overall.

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.

Ben Sasse is a Republican U.S. Senator from Nebraska. As you might imagine, he's not a fan of the ACA.

About an hour ago, he tweeted the following:

Just heard from small-biz owner--whose plan was cancelled by ObamaCare--that he's been forced into this:
$13k/yr deductible
$15k/yr premium

— Ben Sasse (@BenSasse) April 28, 2017

...which I thought would be the first tweet in a brief thread including some additional details, such as:

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I crunched the numbers for Texas, it's actually easier to figure out how many people would lose coverage if the ACA is repealed in non-expansion states because you can't rip away healthcare coverage from someone who you never provided it to in the first place.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

A few days ago I noted that up to 50,000 South Dakota residents who previously held out at least had some hope that the state might expand Medicaid under the ACA next year have already had that hope yanked out from under them like a rug:

A proposal to expand a federal health insurance program for needy people could be off the table following the results of Tuesday's election.

The victory of Republican Donald Trump, who has called for a repeal of Obamacare, along with the increasingly conservative Republican make-up of the South Dakota state Legislature could thwart Gov. Dennis Daugaard's efforts to expand Medicaid in the state.

Well, the same dynamic is already playing out in Nebraska as well:

Trump win sinks effort to expand Medicaid in Nebraska

Today (Friday, Sept. 23) happens to be the deadline for insurance carriers to sign agreements with the federal government for participating in the exchange this Open Enrollment period (I'm not sure if today's deadline also applies to the state-based exchanges or not; they might be different). Until today, it looked as though there were going to be 3 carriers offering individual policies on the Nebraska exchange:

The figures compared 2016 and 2017 rates for Blue Cross Blue Shield of Nebraska, Aetna Health Inc. and Medica, the three companies that will offer policies to Nebraskans on the exchange when open enrollment starts Nov. 1.

However, as commenter M E noted, it looks like BCBSNE decided to wait until literally the last minute (last hour, anyway) to change their minds:

Huh. Back in June, when I first ran the requested rate hike numbers for Nebraska, it looked as though there were only two real carriers offering individual plans, either on or off the exchange: Blue Cross Blue Shield and Medica. UnitedHealthcare announced they were leaving NE along with a bunch of other states, and Coventry (aka Aetna) didn't have any filings for 2017, so I assumed they were bailing as well. Finally, the less time spent talking about "Enterprise/Freedom Life" the better. So...it looked like BCBS and Medica were it. Here's what the table looked like:

Hmmm...last year Nebraska had 5 carriers offering individual policies, 2 of which were actually divisions of the same company (UnitedHealthcare). Since United is pulling out of Nebraska, this leaves only three companies...one of which is the mysterious "Freedom Life Insurance Co." which keeps popping up in numerous states as not having a single actual enrollee, and almost always asking for the exact same rate hike: 17.37%. What's up with that?

Anyway, Coventry (actually Aetna) appears to also be gone next year as well...or perhaps they simply haven't submitted their rate filings yet? I suspect the latter because Nebraska's total individual market was over 110,000 people as of 2014, and is likely up to over 130K this year (nearly 88,000 enrolled via the ACA exchange alone this year)...yet adding up the numbers from the official filings only totals around 30,000 people.

With 47 states plus DC under my belt, at this point I'd say I have a pretty good feel for the overall national premium rate increase scene; it still looks like around 12-14% nationally on average, ranging from a low of under a 1% average hike in Maine and Indiana to a high of 40% or so in Alaska and Minnesota.

However, I admit it would be nice, as a point of personal pride, if I could squeeze in the last three states: Nebraska, Pennsylvania and Wisconsin. Fortunately, Louise Norris has brought to my attention the fact that the Nebraska Dept. of Insurance has issued the final approved rate changes for the individual market:

This is an incredibly depressing post for me to write. Last month I received word that CoOportunity Health, one of the 23 co-ops set up as part of the ACA to offer competition with the Big Boys, had run into serious financial trouble and was being yanked off of Healthcare.Gov (they were operating in Iowa and Nebraska, both of which are on the federal exchange).

This surprised me because from everything I had heard, CoOportunity was doing quite well, with upwards of 120,000 QHP enrollees last year. I've written about them several times in the past, and have kind of a special fondness for them because they were one of the first sources I had for solid OFF-exchange QHP enrollment data.

Anyway, as of December 10th, my contact at CoOportunity was unaware of any issues; they reported that everything was going great. On Christmas Eve, I was tipped off about CMS dropping CoOportunity from the exchange completely, but there wasn't a whole lot of detail given as to what had gone wrong beyond vague references to quarterly financial statements, cash flow and annual audits.

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