Nevada

About a month ago, I crunched Nevada's individual and small group rate hike numbers and concluded that the overall weighted average hike in the Silver State next year (assuming everyone stays put and doesn't shop around) will be roughly 9.6% on the individual market and just 5.3% for small businesses.

Today, the Nevada Appeal ran a story claiming the ACA exchange-only average individual rate hike will be around 8.7%.

Now, it's not the lower rate which caught my eye; the 8.7% figure only includes exchange-based carriers, of which there's only three this year, versus the dozen or so who operate throughout the state (there are 9 more insurance carriers who are only operating off of the exchange).

What I'm puzzled by is this part...which also includes some good news:

Nevada's insurance dept. rate filing website has an extremely user-friendly, interactive website which lets you drill down and find exactly what you're looking for: Individual or Small Group policies, HMO or PPO, Under Review or Reviewed. From what I can tell, there are 12 companies offering individual policies in 2016 (a 13th, the Nevada Health COOP, just announced that they've gone belly-up and are being dissolved, meaning a minimum of 16,000 Nevadans will have to switch to a different insurance carrier).

The requested rates were approved for 8 of the companies, but were reduced significantly for Aetna (from 21-24% down to 15%). Here's what it looks like in the end:

The Small Group market is faring somewhat better, with just a 5.3% overall weighted average increase:

After yesterday's ugly news about Alaska's private policy rate hikes, this is welcome relief:

Judge says Alaska Medicaid expansion can go ahead Tuesday

An Anchorage trial court judge Friday said that Alaska Gov. Bill Walker’s administration can expand the Medicaid health care program starting next week, dismissing a request by the state Legislature to temporarily block enrollment while attorneys fully argue lawmakers’ legal challenge.

In a 45-minute opinion delivered from the bench, Pfiffner rejected a series of arguments by the Legislature that starting expanded Medicaid enrollment Tuesday was so problematic that it should be put on hold while the Legislature’s lawsuit proceeds.

The actual lawsuit will still proceed, but this is still great news for up to 40,000 Alaskans.

Not such great news in Nevada, however:

Nevada Health Co-Op to close, leaving thousands to find new insurance

The impending King v. Burwell Supreme Court decision will cast an even larger shadow over the ACA over the next 2 months (the decision is expected to be announced in June), as exchanges in 6 of the 14 states running their own (State-Based Marketplaces, or SBMs) are at risk of either being abandoned, dissolved or otherwise moved over to the federally-run Healthcare.Gov exchange:

The federal government is threatening to take over Hawaii's health insurance exchange within months and has restricted grant money to support operations of the Hawaii Health Connector.

Jeff Kissel, the Connector's executive director, told lawmakers at a briefing Thursday that if the exchange created by the Affordable Care Act does not get state funding soon, the federal government will abolish Hawaii's marketplace and run it directly.

This isn't an exact apples-to-apples comparison, since the Massachusetts number includes the "overtime" extension period while the other 5 states only run through 2/15/15, but I thought it would be useful to see how the 6 exchanges which had widespread technical issues last year fared this time around. Obviously  other states like Washington and California had some snafus, but these are the ones which were seriously hosed last year to the point of requiring massive overhauls or which were completely scrapped in favor of a new platform (I'm not including HC.gov itself here since everyone already knows what massive technical improvements they've made).

The chart below refers specifically to QHP selections only (whether paid or not), and compares the 2015 open enrollment period (11/15/14 - 2/15/15...or 2/26 in the case of MA) against the 2014 open enrollment period (10/1/13 - 4/19/14). I've also included some notes for context.

This is a nice article giving a status report on how things are going in Nevada (which, along with Oregon, scrapped their own ACA exchange last year and moved over to Healthcare.Gov). It includes a straightforward enrollment number: "more than 10,000" right in the title.

However, the wording of the article makes it unclear as to whether that number includes unsubsidized QHP enrollments or just the 85% or so who qualify for tax credits:

Compared to last year’s rollout, Nevada Health Link is showing stronger numbers so far in this year’s open enrollment.

More than 10,000 Nevadans have enrolled for subsidized health care plans through the state insurance program.

The enrollment numbers are good news and show signs of improvements at Health Link, Nevada’s online health care market.

At this time last year, only 6,000 people had signed up. It was Health Link’s first year online.

The comparison number below (6,000 last year) make it sound like 10K includes everyone, but the "subsidized" caveat makes it sound like it doesn't, in which case the total number should be roughly 11,700 or so.

I'll go with the lower 10K number for now, however.

OK, not an exact number, but this story ran on 11/20, the 6th day of 2015 open enrollment, so...

Nevada Health Co-op, based in Las Vegas, was created to offer affordable health insurance, and to compete with other companies offering insurance in our state. Since open enrollment began Saturday, the Nevada Health Co-op has been very busy.

Director of Business Development Patti McCoy says they have been enrolling about 100 people a day.

Again, like my initial entries for Illinois and Oregon, this is only for a single insurer out of several operating in the state, so the actual QHP enrollment number is likely considerably higher.

I've ranted several times before about the importance of current Obamacare private policy enrollees making sure to actually visit the exchange website, shop aroundlog into your account and manually re-enroll for 2015, even if nothing has changed at your end (ie, no changes in income, dependents, residence etc).

There are many reasons NOT to auto-renew, most of which are financial in nature. The short version is, you could easily end up paying more than you thought next year by not switching (in addition to premium changes, your tax credit might drop even if your income hasn't changed due to how it's calculated), and you could pay substantially less next year if you do switch to another policy (premiums are actually dropping in many markets).

I addressed Nevada's apparent attrition rate about a month and a half ago. At the time, it appeared to be a fairly ugly 7.7% per month...relative to the "high water mark" of paid enrollments they had achieved in July of around 38,000.

However, since then I've realized that given the high amount of churn during the off-season as people enter and leave the marketplace, a far more accurate measure is the number of current enrollees relative to the April tally, since that was the "8.02 Million Total / 7.06 Million Paid" figure that everyone was focusing on anyway. Doing it this way is also far more consistent, since there's a hard 4/19 number to compare against for every state instead of it being all over the map.

In the case of Nevada, I've just received word that the current number of people enrolled in exchange QHPs is exactly 32,460 as of mid-October.

There's been a lot of fuss made about 2015 ACA exchange premium rates not being available at Healthcare.Gov until after the election. The presumption, of course, is that this is being done for political reasons. While this may be true, it could also simply be that there's a lot of different policy figures to plug into the federal system, and some states haven't even finalized their rates yet.

That being said, residents of some states can check out the 2015 premiums now and compare them against their current premium:

IDAHO: Idaho is the only state moving from HC.gov to their own exchange. Idaho residents can check out their 2015 rates directly via the state exchange site.

CALIFORNIA: CoveredCA has 2015 rates available right now as well.

COLORADO: Exchange COO joins exodus, new system late

Colorado’s 2.0 “Kentucky-style” system that is supposed to simplify the way people get health insurance won’t be ready until days before the Nov. 15 open enrollment starts.

And as Colorado’s health exchange enters its busy season, a third “chief” has announced she’s leaving Connect for Health Colorado. Chief Executive Patty Fontneau departed in August. Chief Financial Officer Cammie Blais left two weeks ago. And Chief Operating Officer Lindy Hinman announced her resignation and plans to leave next month after open enrollment begins.

VIRGINIA: Funds to help Va. health care coverage signups

Virginia is getting $9.3 million in federal funding to help residents sign up for health insurance.

Gov. Terry McAuliffe said the money will help hire more than 100 people to help with enrollment that runs from Nov. 15 through Feb. 15.

WASHINGTON: Health Exchange leaders are trying to solve the problems from the first sign-up period

CLARKSTON, WA – Leaders with Washington’s Health Care Exchange are preparing for the second open enrollment period, but at the same time they are still working on resolving billing and computer problems for 1,300 accounts from the first sign-up period.

IOWA: Three health insurers get OK to increase rates

This is very confusingly worded, because it makes it sound like all 3 companies have been operating on the HC.gov exchange when it turns out that only 2 of them have. Wellmark did not participate in the ACA exchange; the 19,000 customers referred to here have off-exchange policies which are still ACA-compliant:

Commissioner Nick Gerhart said today that he has approved premium increases from Wellmark Blue Cross and Blue Shield, CoOportunity Health and Coventry Health.

Three important pieces of information about Nevada's exchange out of this article:

1. NV's move to HC.gov will be permanent. The original plan was to only move to the federal exchange for 2015, then moving back to their own (2nd attempt) platform for 2016, which frankly always sounded a bit silly to me. There were lots of reasons for the states to run their own exchanges originally (federal cash to do so, autonomy/local control, etc.), but the federal funding will have dried up by then, and if everything is running smoothly at HC.gov, I'm not sure I see the point in uprooting the whole system at that point. Frankly, there's really only one major reason I could see to move back to their own platform, but...

2. While NV will be using the HC.gov software platform, they'll still legally be considered a state-run exchange, which means that they're safe from any potential SCOTUS Halbig/King fallout. This is basically the entire point I was making way back on July 2nd with my "Domain and a Splashpage" solution.

Whoops...found even more slightly-outdated ACA-related articles worth noting...

OREGON: Cover Oregon officials hope to repair broken state health insurance exchange for 2016

For those who assume Cover Oregon will go away when the federal government takes overthe state exchange's job of enrolling people in health coverage, think again.

Even as Oregon works on hooking up to the federal website by November, some Cover Oregon board members hope the engagement with Uncle Sam will be only a one-year affair.

I found one quote in particular to be a bit of an eyebrow-raiser:

But the idea is controversial on both sides of the political aisle in Salem.

"Hell, no," says Sen. Brian Boquist, R-Dallas. He thinks Oregon should leave the job to the federal exchange and Cover Oregon as a stand-alone agency should go away. "Cover Oregon, the whole structure is bad from beginning to end. I don't trust the federal government. But I do trust the federal government more than I do the state of Oregon."

I've been too busy with my day job (I do have one, you know...) to post much lately, but plenty of ACA-related news has piled up, so I'm clearing off my desk with some quick hits:

HEALTHCARE.GOV: Lack of Back End Software for Federal Exchange

One of the big news stories in 2013 and early 2014 was the botched launch of the federal Exchange (and several key state Exchanges), which led to many Americans having to wait to be enrolled in an ACA-sanctioned health plan.  Although some technical snafus have been addressed, many still remain.  For example, a top White House official told Congress recently that the automated system to send payments to insurance companies is still under development, and didn't offer a completion date. The lack of an electronic verification process is only one part of the "backend" of the software that is still problematic five years after the Act was passed.

NEVADA: After health care debacle, Gov. Brian Sandoval reluctantly extends Nevada’s ties with Xerox

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