Insurance Commissioner Announces Single-Digit Aggregate 2018 Individual and Small Group Market Rate Requests, Confirming Move Toward Stability Unless Congress or the Trump Administration Act to Disrupt Individual Market
Of the 31 states which have expanded Medicaid under the Affordable Care Act, only a handful issue regular monthly or weekly enrollment reports.
Back on February 28th I noted that ACA Medicaid expansion enrollment across three states (Michigan, Louisiana and Pennsylvania) had grown by about 35,000 people since mid-January, to 667K, 406K and 716K people respectively.
Today, a month later, I decided to take another look at all three states, along with Minnesota (which I forgot to check last month). Sure enough, enrollment has continued to grow in all four, albeit at a slower pace:
While this project has received high praise as a useful resource, one problem with it is that the numbers aren't static--between the high churn rate of the individual market and Medicaid, as well as the fact there's no limited enrollment period for Medicaid (you can sign up year-round), the enrollment figures are constantly changing.
Over 700,000 Additional Pennsylvanians Enrolled in Governor Wolf’s Medicaid Expansion Plan
February 02, 2017
Harrisburg, PA – In February of 2015, Governor Wolf expanded Medicaid to ensure that Pennsylvanians can receive affordable, straightforward, accessible healthcare without unnecessary delays and confusion. Today, Governor Wolf announced that over 700,000 Pennsylvanians have enrolled in HealthChoices, Pennsylvania’s mandatory managed care Medicaid program, since expansion occurred two years ago. U.S. Census data shows that the commonwealth’s uninsured rate has dropped from 10.2 percent in 2010 to 6.4 percent in 2015.
(thanks to commenters "M E" and "joe" for the heads up).
The state Dept. of Insurance has released their approved rate hikes for 2017, and it's bad news in two different ways. First, the overall full-price average rate increase looks like it'll be roughly 32.5%...over 8 points higher than the original rates requested by the carriers. Secondly, even with those higher increases, two more indy market carriers (Keystone Health Plan and Geisinger Quality Options) are pulling off the exchange, although both will continue to offer off-exchange plans.
It's important to be careful with the full carrier names here, because they often operate under several different very similar ones (Keystone Health Plans vs. Keystone Health Plan East, for instance, which is not pulling off the exchange).
Yesterday I hobbled together the weighted average rate hikes (either requested or approved) for the ACA-compliant small group markets across 15 states. In 4 of these states, I hadn't yet tallied the weighted average, so I temporarily used the median increase for each. In the case of Pennsylvania, the range was from a 3.8% decrease to a 33% increase, with a midpoint of around 14.6%.
Today, however, I've actually plugged in the enrollment numbers for each sm. group carrier in Pennsylvania based on their 2017 rate request filings, and have come up with a weighted average of just 7.9%:
Last year, the insurance carriers in Pennsylvania asked for a weighted average 15.6% rate increase for individual market policies...but in the end state regulators knocked these down by over 1/5th to around 12% overall.
This year the picture is uglier, as expected. While four of the filings are for rate hikes of under 10%, this is misleading because one of them appears to be brand new while the other 3 have a combined enrollment of...7 people. Not 7,000, not 700...seven.
The rest of the filings range from 16% to a whopping 48% increase request from Highmark Health Insurance for over 20,000 enrollees. Ouch.
Overall, the weighted state-wide average requested rate hike on the individual exchange is 23.6%.
I was fascinated when I saw this phenomenon happen here in Michigan last year, but it's repeated itself in several other states since then. State and federal officials crunched their demographic data and came up with estimates of the maximum number of residents who they expected to be eligible for the ACA's Medicaid expansion provision a couple of years back, along with the number of those expected to enroll in the program in the first year. They're then caught offguard when not only does the actual number eligible turn out to be far higher than they expected, but far more of those eligible go ahead and sign up in the first year than expected.
In Michigan, estimates ranged from 477K - 500K being eligible; instead, the number broke 600,000 the first year, where it's hovered around ever since (as of last week it stood at 615,536).