Pennsylvania

Back in early August, the Pennsylvania Insurance Dept. issued the preliminary rate filings for PA's individual and small group market carriers. At the time, the weighted average rate change being requested on the individual market came to a 2.6% reduction in unsubsidized premiums, while the average small group plan was set to increase by 2.3%.

Last week, the PA DOI issued their final decisions for the long list of carriers on each market, and the changes were...minimal, really. In fact, there was no change at all made to most requested rate filings--only two of the 17 indy market carriers saw a change (reductions for each), and only four of the 21 small group carriers did...and even then, the changes aren't terribly dramatic, just a few percentage points in most cases.

Here's the press release:

Insurance Department Announces Lower ACA Individual Plan Health Insurance Rates, Attributes Them To New State-Based Exchange And Reinsurance Program

Pennsylvania launches new state-based health insurance marketplace, Pennie

  • Pennie replaces Healthcare.Gov and will improve access to coverage and increase affordability

Harrisburg, PA – September 22, 2020 – Today, Pennsylvania announced, Pennie, the new state-based health insurance marketplace for 2021 coverage. Pennie is available to all Pennsylvanians and aims to improve the accessibility and affordability of individual market health coverage. It is also the only place that connects Pennsylvanians to financial assistance to reduce the cost of coverage and care.

Pennie was created by Act 42 of 2019, passed unanimously by both chambers of the General Assembly and signed into law by Governor Tom Wolf on July 2, 2019.

Yesterday the Pennsylvania Insurance Dept. posted the preliminary 2021 rate filings for the individual and small group markets. On the surface, it appears that Pennsylvania has an absurdly competitive market, with 17 carriers listed on the indy market and 21 small group carriers...but when you look closer, many of these are simply branches of the same main company.

For instance, fully five of the individual market carriers are variants of "Highmark"...which is actually Pennsylvania's rebranding of Blue Cross Blue Shield. Two are branches of Geisinger and another two are both UPMC. The same is true in the small group market.

And don't even get me started about "Capital Advantage Assurance Company" and "Capital Advantage Insurance Company". Sheesh.

In any event, the overall rate filings average out to rougly a 2.6% premium decrease on the individual market and a 2.3% increase for small group plans, when weighted by carrier market share.

Between the COVID-19 pandemic and just getting generally swamped, I haven't gotten around to writing about Pennsylvania's state-based ACA exchange, due to launch this fall, since way back in December:

PA’s A Step Closer To Starting A State-Based Health Insurance Exchange

Pennsylvania’s new, state-run health ​insurance exchange is getting rolling ahead of its launch in 2021.

The commonwealth has chosen a California-based company, GetInsured to run it.

...Zachary Sherman, who heads the newly-created Pennsylvania Health Insurance Exchange Authority, said the contract with GetInsured will cost around $25 million annually, plus startup expenses that’ll be spread over several years.

“That’s compared to what we currently pay for Healthcare.gov, which is in the $90 to $95 million range,” he said.

Sherman said the administration chose GetInsured because it has already contracted with other states, like Nevada and Minnesota.

He said the new exchange is expected to save people between five and ten percent every year on premiums.

Over the past few days, I've collected and analyzed the daily COVID-19 cases at the county level in Michigan and Wisconsin to see what patterns are emerging as time goes by. I've tried to do this via two criteria: Population density (urban vs. rural) and politically (red vs. blue). The latter, of course, shouldn't even be a thing, but of course it is; pretty much every policy decision being made by the Trump Administration is based on tribal politics, so it'd be naive not to look at the data in that light.

So far, I've found clear and obvious trends in both midwest states, which happen to be two of the three most closely-watched swing states this year: While the urban centers (Detroit/Metro Detroit in Michigan; Milwaukee/Madison in Wisconsin) started out with much higher rates of infection than the rest of the state, over the past few weeks this has shifted dramatically, and appears set to continue to do so.

Last March I wrote an analysis of H.R.1868, the House Democrats bill that comprises the core of the larger H.R.1884 "ACA 2.0" bill. H.R.1884 includes a suite of about a dozen provisions to protect, repair and strengthen the ACA, but the House Dems also broke the larger piece of legislation down into a dozen smaller bills as well.

Some of these "mini-ACA 2.0" bills only make minor improvements to the law, or make improvements in ways which are important but would take a few years to see obvious results. Others, however, make huge improvements and would be immediately obvious, and of those, the single most dramatic and important one is H.R.1868.

The official title is the "Health Care Affordability Act of 2019", but I just call both it and H.R.1884 (the "Protecting Pre-Existing Conditions and Making Health Care More Affordable Act of 2019") by the much simpler and more accurate moniker "ACA 2.0".

I haven't written anything about Pennsylvania's surprisingly bipartisan decision to break off of the federal ACA exchange at HealthCare.Gov onto their own state-based exchange since June:

After some last-minute drama in one state and a surprising lack of drama in another, both New Jersey and Pennsylvania have officially passed bills allowing them to each establish their own ACA exchanges and enrollment platforms, splitting off from the federal exchange and HealthCare.Gov:

Pennsylvania:

Pennsylvania is poised to roll out its own online health insurance exchange to take the place of the one run by the federal government for the state's residents since 2014, saying it can save money for hundreds of thousands of policy-buyers.

Back in July, the Pennsylvania Insurance Dept. posted the preliminary/requested 2020 average premium rate changes for the individual and small group markets. The ACA-compliant individual market average increase was around 4.6%; for small businesses, the average was 9.6%.

Today they finally posted the approved rate changes for each...and the indy market average has dropped to a 3.8% increase, while the small group market has gone up just a hair to 9.7%.

MLR rebate payments for 2018 are being sent out to enrollees even as I type this. The data for 2018 MLR rebates won't be officially posted for another month or so, but I've managed to acquire it early, and after a lot of number-crunching the data, I've recompiled it into an easy-to-read format.

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:

This Just In from the Pennsylvania Insurance Dept:

Insurance companies offering individual and small group health insurance plans are required to file proposed rates with the Pennsylvania Insurance Department for review and approval before plans can be sold to consumers. The Department reviews rates to ensure that the plans are priced appropriately -- that is, they are neither excessive (too high) nor inadequate (too low) -- and are not unfairly discriminatory.

Rates reflect estimates of future costs, including medical and prescription drug costs and administrative expenses, and are based on historical data and forecasts of trends in the upcoming year. In its review, the Department considers these factors, as well as factors such as the insurer's revenues, actual and projected profits, past rate changes, and the effect the change will have on Pennsylvania consumers. For more information on this process, watch our How Are Health Insurance Rates Decided?Opens In A New Window video.

After some last-minute drama in one state and a surprising lack of drama in another, both New Jersey and Pennsylvania have officially passed bills allowing them to each establish their own ACA exchanges and enrollment platforms, splitting off from the federal exchange and HealthCare.Gov:

New Jersey:

New Jersey Gov. Phil Murphy signed into law a bill establishing a state-based health care marketplace.

Murphy signed the legislation on Friday in a private ceremony.

Under current law, New Jersey uses a federal exchange, or marketplace, letting people shop for and enroll in coverage under the Affordable Care Act.

Last night I wrote a long entry noting that Pennsylvania, which has a Democratic Governor but a Republican-controlled state legislature, is taking swift action today to pass a bill allowing PA to establish their own state-based ACA healthcare exchange:

Pennsylvania is moving to take over the online health insurance exchange that’s been operated by the federal government since 2014, saying it can cut health insurance costsfor the hundreds of thousands who buy the individual Affordable Care Act policies.

New legislation unveiled Tuesday has high-level support in Pennsylvania's House of Representatives, with the chamber's Republican and Democratic floor leaders as the bill's lead co-sponsors.

A House committee vote was scheduled for Wednesday, underscoring the urgency of the legislation.

The bill is backed by Gov. Tom Wolf, a Democrat, and his administration says it would make two important changes to reduce premiums for the 400,000 people who purchase health insurance through the Healthcare.gov online marketplace.

Until now there's only been one state which started out hosted by HealthCare.Gov which has gone on to break off onto their own platform: Idaho, which made the move with no drama back in 2014

In Idaho's case, this was always the plan from the start; they simply didn't have time to launch their own exchange before the 2014 Open Enrollment Period, so they bumped it back a year. Idaho is about to lose that unique status, however, in a big way.

Back in March, the House Democrats held a press event in which they officially rolled out the "Protecting Pre-Existing Conditions and Making Healthcare More Affordable Act", or #PPECMHMAA for short. That's a simply terrible title and an even worse hashtag, so I've simply shorthanded it as #ACA2.0.

The bill is actually a suite of a dozen smaller bills. Nearly all of them are sponsored purely by Democrats, which isn't surprising...but there's one exception:

OK, I had kind of forgotten about this. Back in early June, insurance carriers in Pennsylvania submitted their preliminary 2019 ACA market premium change requests. At the time, they averaged around a 4.9% increase statewide, which seemed pretty impressive under the circumstances.

Then, late July, the PA insurance department issued a press release stating that state regulators had modified the 2019 requests, and that the new, revised average was much lower...a mere 0.7% average rate hike. However, the individual carriers as well as the insurance department made it very clear that this nominal increase included a 6 point rate increase to account for the ACA's individual mandate being repealed and the Trump Administration's expansion of non-ACA compliant short-term and association plans.

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