Nevada

This Just In from the Nevada Insurance Dept...

Proposed rate change averages for health insurance are available to the public for review

Consumers who shop for health insurance in the individual market, can now view new rate information for Plan Year 2020 on the Nevada Division of Insurance website.

Based on the rate submissions the Division has received for 2020 plans, there are three insurance companies that submitted proposed rates for plans on the Silver State Health Insurance Exchange (Exchange): Health Plan of Nevada, SilverSummit, and HMO Colorado, with up to 26 individual health plans to choose from. The proposed average increase is 0.5% for those health insurance plans sold On-Exchange through Nevada Health Link.

About three weeks ago I noted that the Nevada state Senate had passed a bill which locks in many of the ACA's patient protections at the state level, just in case the idiotic #TexasFoldEm lawsuit prevails and the ACA is repealed after all.

Yesterday, the Nevada state House followed through as well:

Nevada stands to become the fifth state to fully incorporate the federal Affordable Care Act’s protections for patients with pre-existing conditions into state law after unanimous passage of a bill Tuesday in the state Senate.

"Fully incorporate" isn't quite accurate; as I noted with the Senate version, it looks like the three most important ones are covered (Guaranteed Issue, Community Rating and the ACA's 10 Essential Health Benefits), along with a pre-ACA law letting young adults stay on their parents plan until age 24 (but only if they're unmarried and enrolled in school).

There seems to be something in the air this week...or perhaps it just takes roughly 3 months from the time a new legislative session starts for the first legislation to work its way through the process. Whatever the reason, Washington, Connecticut and now Nevada have all made major moves towards codifying ACA patient protections at the state level in the even the ACA itself is repealed:

The Nevada Senate has passed a bill that would enact state-level health care protections for people with pre-existing conditions.

State Sen. Julia Ratti says the legislation aims to bring about protections that are already in place under the Affordable Care Act. The Democrat told lawmakers last month that people are worried about their health care access.

She says Nevada should make sure these protections are in place at the state level if the federal provisions are rolled back.

State senators approved the measure on Monday in a unanimous vote.

The measure stipulates that insurers cannot deny a person health care coverage due to a pre-existing condition.

As I noted a few weeks ago, I haven't written a whole lot about the idiotic (but terrifyingly so) TexasFoldEm lawsuit in awhile. Part of this is because I was out of the country over the holidays; part is because there hasn't been a whole lot of movement on the case since right-wing federal Judge Reed O'Connor ruled that the ACA was unconstitutional using a legal argument so thin it hula hoops with a Cheerio.

Anyway, when I last checked in, a coalition of Attorneys General from 16 states (plus the District of Columbia) had formally filed to appeal Judge O'Connor's ruling, and the U.S. House of Representatives had also formally voted to intervene on behalf of defending the ACA from the lawsuit, which was filed last year by a coalition of 18 Republican Attorneys General, plus two Republican Governors.

I ran the numbers for Nevada's preliminary 2019 ACA individual market rate changes back in July. At the time, the average requested rate increase was around 2.3% statewide.

With the 2019 Open Enrollment Period coming up fast, I checked on the approved rate changes and found that state regulators had cut down on the rates quite a bit...although mostly for carriers which only offer off-exchange plans and only have small numbers of enrollees anyway.

For instance, HMO Colorado (dba HMO Nevada) originally requested a 20.9% increase; this was reduced to 9.5%...but they only have 200 people enrolled anyway, so it's not even a rounding error. Rocky Mountain was cut from 34.4% to 18.5%...but only has 300 enrollees, and so on.

The three carriers which hold the vast bulk of the market had far less dramatic changes, although Silver Summit was cut from a 5.2% increase to a 1.1% decrease for 2019.

Breaking out of Nevada...

The cost of plans through Nevada’s health insurance exchange are anticipated to only increase by an average of 1.9 percent next year in what the state’s insurance commissioner said is the lowest proposed rate increase from insurance companies since the Affordable Care Act went into effect in 2014.

The announcement, made by the Division of Insurance late Tuesday morning, comes amid ongoing uncertainty about the impact that Congress’s repeal of the Affordable Care Act’s individual mandate and federal rule changes for two types of non-ACA-compliant health plans will have on the individual market as a whole. Insurance Commissioner Barbara Richardson cautioned that the proposed rates are subject to change based on any action by the federal government and said the division is working “diligently” to review the proposed rates from insurance companies.

That 1.9% figure is slightly misleading, though, because...

 

On October 1st, 2013, the first Open Enrollment Period (OE1) under the Affordable Care Act kicked off to much hoopla. As everyone knows, the largest of the ACA exchange websites, HealthCare.Gov, infamously melted down at launch due to a multitude of hardware and software problems ranging from insufficient server capacity to poor workflow design to buggy coding and much, much more. However, as Steven Brill detailed in the March 10, 2014 issue of Time magazine, by early December, the worst of the problems had been resolved, and by the time the second Open Enrollment Period came along a year later, HealthCare.Gov had been completely overhauled, with additional improvements and enhancements every year since.

The difference has been dramatic: On October 1, 2013, only six people (not six thousand or six hundred...six) were able to actually make it all the way through the HC.gov interface and enroll in a healthcare policy. On December 15, 2016, six hundred and seventy thousand enrolled.

Protect Our Care is a healthcare advocacy coalition created last December to help fight back against the GOP's attempts to repeal, sabotage and otherwise undermine the Affordable Care Act. This morning they released a report which compiled the approved 2018 individual market rate increases across over two dozen states.

Needless to say, they found that the vast majority of the state insurance regulators and/or carriers themselves are pinning a large chunk (and in some cases, nearly all) of the rate hikes for next year specifically on Trump administration sabotage efforts...primarily uncertainty over CSR payment reimbursements and, to a lesser extent, uncertainty over enforcement of the individual mandate penalty.

I don't have much to add except the following:

  • Regardless of the shooter's supposed "motivation", this was a terrorist act, plain and simple.
  • Whatever purpose the NRA may have once had, it no longer serves any function other than aiding & abetting terrorism.

A week ago, Vox's Sarah Kliff reported that the Trump Administration was slashing the 2018 Open Enrollment Period advertising budget by 90% and the navigator/outreach grant budget by nearly 40%. As I noted at the time, the potential negative impact of these moves on enrollment numbers this fall--coming on top of the period being slashed in half, the CSR reimbursement and mandate enforcement sabotage efforts of the Trump/Price HHS Dept. and the general confusion and uncertainty being felt by the GOP spending the past 7 months desperately attempting to repeal the ACA altogether could be significant. In states utilizing the federal exchange (HealthCare.Gov), 2017 enrollment was running neck & neck with 2016 right up until the critical final week...which played out under the Trump Administration, which killed off the final ad/marketing blitz.

Result? A 5.3% total enrollment drop (or 4.7% if you don't include Louisiana, which expanded Medicaid halfway through the year) via HC.gov, while the 12 state-based exchanges--which run their own marketing/advertising budgets--saw a 1.8% increase in total enrollment year over year.

Nevada is the final state to post their requested rate hikes for 2018 (or at least they're the last one I tracked down, anyway). I've now done at least a rough analysis of all 50 states + DC, and while some of the data is a bit outdated (remember, I started doing this back in late April/early May), most of it should still be fairly close to the present situation...at least in terms of requested rate hikes.

In Nevada, after much concern that a bunch of rural counties wouldn't have any exchange carriers at all, Centene stepped in to cover them. They aren't listed in the table below, but since I believe they're new to the state, that shouldn't matter in terms of rate increases since there's no base rates to compare against anyway.

So, I got back from my trip to the NIHCM awards dinner in DC late last night, and am groggily attempting to bone up on all the healthcare stuff which happened while I was gone (ironic, of course, given that I was attending a healthcare-related event filled with other healthcare wonks/reporters).

In the past 2 days...

Of the 31 states which have expanded Medicaid under the Affordable Care Act, only a handful issue regular monthly or weekly enrollment reports.

I noted in February that enrollment in the ACA's Medicaid expansion program had increased by around 35,000 people across just 4 states (LA, MI, MN & PA).

It's early June now, so I checked in once more, and the numbers have continued to grow. I have the direct links for 5 states now (including New Hampshire)...

Hardly surprising given they made good on their "Give us our merger or we're out of here!" threat last year, followed by further drop-outs from both Iowa and Virginia announced for next year over the past few weeks, but the final Aetna shoe has just dropped:

.@Aetna will not offer on- or off-exchange individual plans in DE or NE for 2018, and at this time has completely exited the exchanges.

— T.J. Crawford (@TJatAetna) May 10, 2017

T.J. Crawford is apparently Aetna's head of media relations, so yeah, that seems pretty definitive.

A bit more courtesy of Peter Sullivan of The Hill:

Last month I wrote up a list of 20 fixes/improvements to the ACA, many of which wouldn't cost taxpayers a dime. One fo them was...

12. LEGALLY TIE MEDICARE ADVANTAGE/MANAGED MEDICAID CONTRACTS TO EXCHANGE PARTICIPATION.

Andrew Sprung, Michael Hiltzik and I have all written about this before. I have no idea whether it's even legally feasible/practical or not, but if so, it makes a lot of sense to me: Remember, many of the same carriers whning about losing hundreds of millions of dollars on the individual market are simultaneously making billions of dollars in profit off of their other divisions...which include fat federal and state contracts to manage Medicare and/or Medicaid plans. If they want to play in the managed care sandbox, make exchange participation a requirement as well. I'm not saying they should have to treat it as a loss leader--they'd still be able to raise their premiums at an actuarially responsible rate as appropriate--but they should have to at least participate.

Pages