As I explained, the HIT is one of a several taxes/fees which were originally included in the Affordable Care Act which have either never actaully been enforced or whcih have only been enforced sporadically, and which have now been completely eliminated going forward.
The impact of repealing these taxes on the federal deficit/federal debt is obviously not good...this will collectively increase the already-runaway national debt by several hundred billion dollars over the next decade. That's a whole separate discussion.
In the short term, however, this raises a fascinating one-time opportunity for states to step in and generate some much-needed revenue to be used to reduce healthcare costs for tens of thousands of their residents.
A couple of weeks ago, BeWell NM, the name of the New Mexico ACA health exchange, held their latest board meeting. There's two key things to keep in mind about New Mexico:
First, they've been officially operating as a state-based exchange while "piggybacking" off of HealthCare.Gov since the very first Open Enrollment Period in 2013-2014...but they announced over a year ago that they're following Nevada's (and Idaho's) lead in splitting off onto their own full exchange, starting in 2021.
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:
Back in June, the New Mexico Insurance Dept. posted the preliminary 2020 rate change filings for the ACA individual and small group markets. At the time, the vcarriers were requesting the highest average premium increase in the country for next year: An increase of 13.0%.
The main source of this double-digit hike was New Mexico Health Connections, one of just a handful of original ACA Co-Op carriers to survive. They were requesting a whopping 30% average rate hike for 2020, and with over 1/3 of the market share, this was more than enough to drag the statewide average up. A second carrier, Presbyterian, only sells off-exchange but was requesting a 16.3% increase which also pushed the average up.
Well, today the approved rate filings have been released, and there's several eyebrow-raising developments.
The New Mexico Office of the Superintendent of Insurance website just posted the preliminary 2020 insurance rate filings. Here's the full list, which includes a mish-mash of Individual Market, Large Group and Small Group Market policies, with a Pediatric Dental standalone plan thrown in as well.
It's worth noting that the NM carriers are being very careful to separate out on & off-exchange policies into separate listings even though they're all part of the same risk pool, and they're even separating out off-exchange "Mirrored" policies, which refers to CSR Silver Switching; this is a very good thing.
I've cleaned up the listings and plugged in the weighted average rate increases in the table below this one:
In the 5 1/2 years that I've been operating this website (has it really been that long?), I was surprised (pun intended) to realize that out of the 5,600+ blog entries that I've posted, only 2-3 have mentioned "Surprise Bills" (also known as "Balance Billing", although I think there are some differences between the two):
(sigh) Well, it was a good run while it lasted. As I noted last week, New Mexico's new Democratic trifecta government has been on something of a tear in the first few months of 2019, either passing or advancing a number of positive healthcare policies, including:
In addition, there was one more important piece of legislation which looked like it was going to go through without too much fuss: HB 436, which would simply lock in protections for New Mexico residents with pre-existing conditions at the same level that the Affordable Care Act already does nationally:
HB 436 passed on the House floor by a vote of 40-24 on Thursday afternoon. The bill would bring New Mexico's state law dealing with pre-existing conditions into line with federal law.
Rep. Liz Thomson, the bill's sponsor, says health insurance coverage for people with pre-existing conditions is already protected under the federal Affordable Care Act. She wants New Mexico's state law to do the same.
"Because before the Affordable Care Act came along, insurance companies could discriminate based on gender, they charge women more, and on pre-existing conditions," Thomson said.
A couple of weeks ago, Louise Norris gave me a heads up that not only has the New Mexico Insurance Dept. restricted the sale of non-ACA compliant "short-term, limited duration" plans to be...you know...both short term and of limited duration via regulation...
In September 2018, the New Mexico Office of the Superintendent of Insurance (OSI) and Health Action NM (an advocacy group for universal access to health care) presented details about potential state actions to stabilize the individual market. OSI has the authority to regulate some aspects of the plans, including maximum duration, but they noted that legislation would be needed for other changes, including minimum loss ratios and benefit mandates.
New Mexico’s insurance regulations were amended, effective February 1, 2019, to define short-term plans as nonrenewable, and with terms of no more than three months. The regulations also prohibit insurers from selling a short-term plan to anyone who has had short-term coverage within the previous 12 months.
The contrast in how a completely Republican-held state government like Utah and a completely Democratic-held state government like New Mexico deal with Medicaid is pretty astonishing.
In Utah, just four months ago the public voted, clearly and unequivocally, to enact a full expansion of Medicaid to all adults earning up to 138% of the Federal Poverty Line...but the GOP state House, Senate and Governor decided to ignore the voters and override their will by cutting the expansion down to a 100% FPL cap, including work requirements, which will cover tens of thousands fewer people while costing the state $50 million more.
In New Mexico, meanwhile, a newly-enabled Democratic trifecta (I believe both houses of the state legislature were already held by Dems, but the Governorship flipped from Republican Susana Martinez to Democrat Michelle Lujan Grisham) has been on a tear in their first month and a half:
