As anyone who's been following the ACA exchange saga over the past few years knows, the original idea was that all 50 states (+DC) would establish their own, individual healthcare exchange, including their own website/technology platform for enrolling residents in private policies (QHPs), Medicaid (supplementing or replacing whatever existing Medicaid system they already had) and small business policies (the ACA's SHOP program). In addition, each state exchange would also have their own board of directors, marketing department, support call center, fee structure for covering the cost of operations and so on.
If things had worked out that way, there would have been 51 different websites where people would enroll in ACA policies, each one independently branded.
That's 2 in one day, the 8th to fold to date and the 4th one which can be specifically connected the Risk Corridor Disaster:
Health Republic Insurance Not Offering Plans in 2016
Lake Oswego, Ore. (Oct. 16, 2015) –Health Republic Insurance, a non-profit health insurance carrier, announced today that it will not offer small group or individual plans on or off exchange in 2016. All current Health Republic individual and small group policies remain in full effect through the end of 2015. Members can continue to see plan providers and claims will be paid under plan terms.
The federal government recently announced it would pay insurance companies only 12.6% of their risk corridor receivable for the 2014 plan year and has created industry-wide concern about when, or if the 2015 risk corridor would be paid.
This AP article provides snippets about a handful of states; it'd be nice if they just released the actual report so we could see the hard expansion numbers (as opposed to the total increase numbers, which are still obviously useful but don't distinguish between traditional Medicaid and ACA expansion enrollees):
In Kentucky, for example, enrollments during the 2014 fiscal year were more than double the number projected, with almost 311,000 newly eligible residents signing up. That's greater than what was initially predicted through 2021.
...At least 14 states have seen new enrollments exceed their original projections, causing at least seven to increase their cost estimates for 2017, according to an Associated Press analysis of state budget projections, Medicaid enrollments and cost details in the expansion states. A few states said they could not provide original projections.
Also hot off the presses, Nick Budnick at the Oregonian reports that OR is the first state to approve final 2016 individual market policy rates. Since Oregon is not allowing "transitional" policies for 2016 (they gave a 1 year extension vs. the 2-3 that some states allowed), this should apply to all individual policies state-wide (as well as small group policies):
More than 220,000 Oregonians who buy their own health insurance will face higher premiums next year, and Portlanders could see some of the biggest hikes in the country.
State regulators have announced the 2016 rates for people who aren't covered by their employers or government programs.
The overall news is not good for consumers. Some insurers had asked the state to approve rates similar to last year's lowest. But many insurers lost money from unexpectedly high costs, so officials proposed raising many rates in preliminary decisions two weeks ago. The final decisions issued Wednesday resulted in a slightly better range of options for consumer.
Way back on April 30th I posted the first in a series of 2016 rate change request entries for Oregon. At the time, the initial news didn't look very good, with the weighted (by market share) average increase looking to be around 23%.
At the time, and since then, I've posted a whole bunch of stuff regarding the importance of keeping calm about these initial rate requests for a variety of reasons. One of those reasons is that none of the initial requests had actually been approved yet. Last year, many large rate increase requests were denied nationally, with only more modest increases being approved by state regulators, and the same is likely to happen in many cases this year.
THIS REMAINS LIKELY TO BE THE CASE OVERALL. However, there's another possibility which, while I always knew was possible, I wasn't aware of actually having happened until today:
OK, I admit this caught me by surprise; last year the first following-year rate increase requests didn't start popping up in the major media until late May (or perhaps they did but I didn't happen to notice until then). My first entry on the subject wasn't until May 17, 2014.
This year, the first state out of the gate with the proposed rate changes is Oregon. There's a reason why I'm emphasizing "requested" and "proposed" here...because it's very important for people to understand that in most states, anyway, the state insurance commissioner can veto rate increases which are out of line. An insurance company can ask for a 10,000% increase...that doesn't mean they're gonna get it.
The numbers are in: It appears that Oregon consumers were fairly price sensitive when it came to choosing health plans this year.
LifeWise had the lowest rates, at $222 a month for a 40-year-old Portlander on a silver plan. Probably not coincidentally, it more than doubled its individual membership in plans that comply with Affordable Care Act guidelines.
As of March 31, LifeWise has nearly 37,000 members in ACA-compliant plans, up from 4,735 last year, according to the Oregon Insurance Division.
The article goes on to tally every single one of Oregon's individual policy QHP enrollees. The bad news is that they don't break them out by exchange vs. off-exchange. The good news is that they specifically clarify that these are all ACA compliant policies (ie, no "grandfathered" or "transitional" numbers included):
Since the 2015 Open Enrollment Period began, in addition to the weekly HC.gov "snapshot" reports which gave state-by-state breakouts of exchange-based private policy enrollments, the Oregon Insurance Division has also been tracking and reporting the number at their site...along with off-exchange (direct) QHP policies. As the only state reporting the off-exchange data on a regular basis, OR has become the only hard source I have for this number (other states like Washington, Florida and Louisiana report off-exchange data as well, but only on a quarterly or annual basis).
Their exchange-based data has always lagged slightly behind the HC.gov number, partly because the thru-dates don't match up and partly because at least one of the insurance companies in Oregon only reports paid enrollments instead of plans selected. Still, with the final week or two of HC.gov data missing at the moment, this is a handy estimate of how things played out in the final "overtime" enrollment week:
Members enrolled, Nov. 15-Feb. 22
On Healthcare.gov 113,219
Outside of Healthcare.gov 102,232
Total 215,451
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.
As noted earlier, there's a lag between the exchange-based QHP data from HC.gov vs. the Oregon Insurance Division, so you can ignore that number. However, the off-exchange number should be accurate (and this is the official source for it anyway):
Members enrolled,
Nov. 15-Feb. 1
On Healthcare.gov 86,606 Outside of Healthcare.gov 95,859
Total 182,465
Last week the off-exchange total was 92,872, so that's about a 3,000 enrollee increase, for whatever that's worth.
According to the HC.gov weekly snapshot report, as of 2 days earlier (1/30), Oregon's exchange-based total was 94,126...slightly less than the off-exchange number. It'll be interesting to see if that ratio holds steady next week after the final deadline surge goes through.
