Pennsylvania

A few weeks ago, Pennie (Pennsylvania's ACA exchange), like several other state-based exchanges, put out a simple statement celebrating the passage of the American Rescue Plan (ARP) and the dramatic improvement in ACA affordability that it brings for the next two years. Like most of the other exchanges, Pennie's initial press release was pretty bare-bones, as the bill had just been signed into law and there were a ton of logistical details to be worked out.

Today, at their monthly board meeting, Pennie provided some further info on how they plan to proceed:

Pennie’s American Rescue Plan Policy Goals

  • Implement ARP provisions as soon as possible, and as broadly as possible, to maximize savings for Pennie customers
  • Automate these provisions, to the extent possible, to ensure that the benefits under the new law reach Pennie customers without requiring customer action
  • Ensure that customers who need to take an action are given specific instructions on what they need to do to maximize their benefits
  • Use this unique opportunity to connect more Pennsylvanians to comprehensive coverage and reduce the number of uninsured throughout the Commonwealth

This is from a couple of weeks ago; I'm reposting it standalone for clarity. via Pennie: (via a text graphic for some reason):

Joint Statement from The Pennsylvania Insurance Dept. & Pennie regarding the American Rescue Plan Act of 2021:

"The American Rescue Plan Act of 2021 will not only provide financial assistance through the forthcoming stimulus checks, but will also provide an estimated $270 million in additional subsidies to current Pennie customers in 2021 alone. Through this law, marketplace premiums will be capped at 8.5% of a household's income, meaning current Pennie customers will see lower monthly premiums and those without coverae or who were previously ineligible will now have access to financial help if they shop at Pennie.com.

In some cases, lower-income enrollees will have their monthly premiums eliminated entirely. Additionally, anyone who was eligible for unemployment income in 2021 will be eligible for coverage thorugh Pennie with a $0 premium for the remainder of the year.

I just received the following COVID Enrollment Period update from Pennie, Pennsylvania's new state-based ACA exchange. This appears to be part of an official report which they're still working on.

The "Existing" numbers refer to current Pennie enrollees who are taking advantage of the COVID SEP to switch to a different plan mid-year; this is something which usually isn't allowed, even during traditional Special Enrollment Periods (SEPs), but Pennie, along with HealthCare.Gov and many of the other state-based exchanges, are allowing them to do so during this period.

There's an obvious reason for this, too: The impending passage of the American Rescue Plan will mean dramatically improved/expanded subsidies for ACA enrollees, including many who haven't been eligible for them until now. This means millions of Americans who enrolled in Bronze plans because they weren't eligible for subsidies will be able to upgrade to Silver or Gold; it also means many people will become eligible for $0-premium plans who currently aren't, and so on.

As I did when Access Health CT released their 2021 OEP report, there's so much data here I'm not gonna bother doing any analysis in this entry; I'll just post the most relevant slides for now.

Note: Pennie refers to it as their 2020 annual report, but the enrollment data refers to the 2021 Open Enrollment Period.

via Pennie, Pennsylvania's new state-based ACA exchange:

Pennie Opens a COVID-19 Enrollment Period Which Will Run Until May 15

  • Uninsured Pennsylvanians or those affected by COVID-19 can visit pennie.comand enroll in a plan through May 15.  

 Harrisburg, PA – February 17, 2021 – Uninsured Pennsylvanians can act now and enroll in 2021 coverage during Pennie’s COVID-19 Enrollment Period. Pennie, Pennsylvania’s state-based health insurance marketplace, is proud to provide individuals across the Commonwealth additional time to enroll in health insurance to protect them and their families from the cost of the COVID-19 virus. This enrollment period is in-line with President Biden’s recent Executive Order and is open for all Pennsylvanians who have been impacted by COVID-19. Anyone otherwise eligible to enroll in coverage through Pennie™ can do so from now until May 15.

The new Pennsylvania ACA exchange, Pennie, just issued their final official 2021 Open Enrollment report and (as expected) is also joining most other states in re-opening for a COVID-19 Enrollment Period:

Press Release – Pennie Exceeds Expectations & Extends Enrollment for COVID-19

  • As a state-based marketplace, Pennie increases new enrollment by 9.7% and raises total enrollment to nearly 338,000. Now, Pennie is offering more time to enroll in plans for those affected by COVID-19.
  • Pennsylvanians who have recently lost health coverage or have been affected by COVID-19 can visit pennie.com and enroll in a plan from February 15 through May 15.

It's turned into an annual tradition: The official annual ACA Open Enrollment Period (OEP) runs from November 1st - December 15th, but most of the state-based ACA exchanges have later deadlines. hThen, right around the 12/15 point, it begins: One by one, some of the state-based exchanges announce further extensions of their deadlines to #GetCovered for the upcoming year.

In some cases they simply bump out the deadline for coverage starting in January, with the final "hard" deadline for February or March coverage staying where it is. In other cases they were never allowing Open Enrollment start dates past January to begin with, so it's the hard deadline which is being extended.

In any event, here's this year's batch of announcements; note that this list could grow longer over the next week or two:

There's no formal press release, but Pennie, Pennsylvania's brand-new state-based ACA exchange just noted via their official Twitter account that they're extending the enrollment deadline for coverage starting January 1st by one week:

IMPORTANT ANNOUNCEMENT! We have extended the deadline! You now have until Tuesday, December 22 to select health coverage that begins New Year’s Day.

— Pennie (@PennieOfficial) December 15, 2020

via Pennie, PA's new ACA exchange:

Governor Wolf Declares Dec. 10 Get Covered 2021 Pennsylvania Day in Support of the National Initiative, Get Covered 2021

  • Pennie stressed the December 15 plan selection deadline and the connection between health coverage and COVID-19 safety

Harrisburg, PA – December 10, 2020 – Today, Pennsylvania leadership announced a statewide partnership with Get Covered 2021 and re-emphasized the vital role that health coverage plays in the overall health and well-being of all Pennsylvanians. Improving access to affordable, quality health coverage is a priority for Pennie, Pennsylvania’s new state-based health insurance marketplace.

Get Covered 2021 is a national initiative promoting COVID-19 safety precautions and the importance of having health coverage. Pennie, in partnership with Pennsylvania leadership, along with 15 other states and Washington D.C., hundreds of health associations, sports figures, and celebrities have joined together to help spread the word to “mask up and get covered.”

via Pennie, PA's new ACA exchange:

December 15 is the Deadline for Individuals to Enroll in Health Insurance Coverage for January 

  • Pennie urges all Pennsylvanians seeking 2021 coverage to enroll this Open Enrollment 

Harrisburg, PA – December 7, 2020 –  Pennie, the state’s new health insurance marketplace is approaching its first enrollment deadline. December 15th is the last day for individuals and families to purchase health coverage starting January 2021. Current and potential customers are encouraged to select a plan by December 15 to ensure continuous coverage.

Pennie allows customers to compare and shop for medical and dental insurance from participating insurers, who are required to offer qualified, comprehensive plans. Pennie is also the only source for financial assistance to help lower the cost of coverage and care and nearly 9 out of 10 of customers qualify for financial assistance

As I've noted several times before, two more states have split off from the federal ACA health insurance exchange (HealthCare.Gov) this year. New Jersey and Pennsylvania have joined twelve other states (and DC) in operating their own full ACA enrollment platform.

In the case of Pennsylvania, they decided to call theirs "Pennie" (Pennsylvania Insurance Exchange), and judging by their first enrollment report, it looks like it's off to a great start:

Open Enrollment Early Highlights

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.

This Just In from the Pennsylvania Insurance Dept...

Insurance Commissioner Highlights Minimal Rate Increases, More Consumer Choice in 2019 Health Insurance Rate Filings

Harrisburg, PA - Insurance Commissioner Jessica Altman today publicly released the 2019 requested rate filings for individual and small group health insurance plans under the Affordable Care Act, highlighting minimal rate increases and increased choices for many Pennsylvania consumers, including a new insurer in the individual market.

“Pennsylvanians want and deserve access to the comprehensive health coverage that the ACA provides. Enrollment over the past few years has remained steady, and this fall enrollees will have more choices, despite the Trump Administration’s relentless efforts to dismantle the ACA,” Gov. Tom Wolf said. “My administration is committed to ensuring that Pennsylvanians remain informed about their growing options and have access to quality, affordable health insurance.”

This is huge news given that Pennsylvania is the 5th largest state in the country (and a swing state to boot)...but it's also incredibly frustrating due what isn't included. From an official Pennsylvania Insurance Dept. Press Release:

Health Insurance Plan Rates Stabilize, Offer More Choice for Consumers Despite Federal Government Sabotage

Harrisburg, PA – Insurance Commissioner Jessica Altman today announced that health insurance rates in Pennsylvania have moderated significantly, counter to the national trend, after Wolf Administration efforts to combat the effects of sabotage on health insurance markets by the federal government and specifically the Trump Administration to dismantle the Affordable Care Act (ACA). Importantly, the filings indicate that rate increases in Pennsylvania will be significantly more modest in 2019 than other states and many consumers will see more choices in their local markets as a result of Pennsylvania's efforts to increase competition.

As you may have noticed, I'm on a bit of a grandfathered/transitional plan data kick this week (there's a reason for it which you'll understand next week). These numbers are tricky to hunt down, since they aren't tracked by the ACA exchanges. Most states either don't track them at all or don't make it easy for the public to locate, and it's even treated as a proprietary trade secret in a few states.

The Kaiser Family Foundation gave a rough estimate of around 2.1 million people still being enrolled in GF/TR plans last year, but they never broke it out by state. Plus, of course, that was last summer; since no one can newly enter these types of policies, their numbers continue to gradually shrink year after year.

Pages