Ohio

UPDATE 11/29/19: This horrific and batshit insane Ohio bill is making the news again six month later thanks to a new Guardian article about it.

The only silver lining I can find here is that the bill doesn't appear to have made any further progress in that time--according to the official Ohio Legislature website, so far it's only been "introduced" and "referred to committee", and those happened back in April. The Guardian article has the number of co-sponsors the same as it was in May as well (19, plus the primary sponsor of the bill).

The tagline for ACASignups.net is "healthcare policy data, analysis & snark", so naturally many of my blog posts have tongue-in-cheek, sarcastic headlines.

This is not one of those times. The headline above is absolutely, sickeningly true.

On a couple of days ago, both houses of the Ohio state legislature--the House and Senate alike--voted to ban abortion outright six weeks after conception. There's no exception for rape. There's no exception for incest. There is an exception for the life of the mother (not her health, mind you...just her actual ability to keep breathing)...but that's it. Yesterday this bill was signed into law by GOP Governor Mike DeWine.

The six-week abortion ban known as the "heartbeat bill" is now law in Ohio. That makes Ohio the sixth state in the nation to attempt to outlaw abortions at the point a fetal heartbeat can be detected.

Ugh:

CMS gives thumbs-up to Medicaid work requirements in Ohio

The Centers for Medicare & Medicaid Services has approved a waiver request for work requirements in Ohio’s Medicaid program.

...CMS rolled out guidance on these waivers in January 2018, and since then eight states, including Ohio, have had requests approved. Several additional states have submitted waivers that the agency has yet to weigh in on.

...Arkansas is the only state where such work requirements have formally been launched, and in the last several months of 2018, more than 18,000 people lost Medicaid coverage as a result of the work requirement. The Kaiser Family Foundation estimated that most of these losses were a result of the administrative requirements associated with reporting work hours.

Double Ugh:

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which would lock in ACA-level protections for those with pre-existing conditions in the event the ACA itself is ever repealed or weakened.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.

As I noted back in June, the Ohio Insurance Dept. doesn't seem to like providing a whole lot of detail about their insurance rate filings on their website; at the time, they only stated the following regarding the preliminary 2019 individual market rate filings:

In 2018, 8 companies sold health insurance products on the exchange in Ohio and 42 counties had just one insurer with an additional 20 counties having only two.

For 2019, 10 companies have filed rates and forms for the Department to review and all 88 counties will have at least one insurer. Preliminary filings show 16 counties with just one insurer and 33 counties with two.

Hmmm...extremely thin detail here, but I'll take what I can get for the moment:

Ohio Health Insurance Exchange 2019

The Affordable Care Act (ACA) requires that every state have an exchange where consumers can buy individual health insurance policies. In Ohio, the federal government runs the health insurance exchange. Ohioans who do not have health insurance through their employer, Medicare or Medicaid may be eligible to purchase coverage through the exchange. Open enrollment for coverage next year (2019) begins November 1, 2018. Below is preliminary data based on the filings submissions of insurers in Ohio. Once filings are approved in late summer/early fall, final information will be posted.

Ohio’s Health Insurance Market (2018–2019)

In 2018, 8 companies sold health insurance products on the exchange in Ohio and 42 counties had just one insurer with an additional 20 counties having only two.

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.

Like Wisconsin and Michigan, Ohio has a high number of carriers statewide...although the per-county competition is still lacking in some areas. Even so, their rate hike requests are still pretty high even with CSR payments being made...and dramatically higher if they aren't.

One interesting tidbit: Check out the CareSource filing letter (first one below the table). They don't mention CSRs or mandate enforcement...but they do specify that a full 5 points of their 23.9% increase request is tied to prescription drug inflation (see Shkreli, Martin)...and even more noteworthy, they say that another 5 points is due specifically to "a number of previously [Medicaid-] qualified individuals" being kicked over to the private exchange, 

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)...

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