The bill in question wasn't terribly complicated; it essentially just placed a new fee on health insurance carriers to finance a new fund which would in turn be used to reduce healthcare coverage costs for low- and middle-income New Mexicans. Furthermore, since some of the fees would be imposed on managed Medicaid programs which are mostly federally funded, it would have leveraged tens of millions of dollars in federal funding as opposed to all of the fees coming from state residents. Had it gone into effect, HB 278 was expected to generate around $125 million in revenue for the state to use to reduce premiums and cost sharing for enrollees.
Back in November, Georgia Governor Brian Kemp released a proposed ACA Section 1332 Waiver proposal which, if it were to be fully approved, would completely transform the ACA individual marketplace into something entirely different:
On November 4, 2019, Governor Brian Kemp of Georgia released a new draft waiver application under Section 1332 of the Affordable Care Act (ACA) that, if approved, would reshape the state’s insurance market. The application reflects a two-phase approach: a state-based reinsurance program to begin in plan year 2021, followed by a transition to the “Georgia Access” model beginning in plan year 2022. Both components of the waiver application would extend through plan year 2025.
NOTE: This is a joint post by three of my colleagues and myself:
David M. Anderson, Charles Gaba, Louise Norris and Andrew Sprung
State policymakers have been prolific and creative in putting forward measures to strengthen their ACA marketplaces. Measures enacted since 2017 or in progress now include reinsurance programs, which reduced base premiums by an average of 20% in their first year in the first seven states to implement such programs; new or renewed state-based exchanges, which capture insurance user fees that can be used for advertising and outreach; state premium subsidies to supplement federal subsidies; and state-based individual mandates, which can provide funding for all of the above.
This Just In via the New Hampshire Insurance Dept...
Governor Sununu and NH Insurance Department Announce Plan to Reduce Premium Rates, Improve Individual Health Insurance Market
CONCORD, NH – Today, Governor Chris Sununu is announcing that the New Hampshire Insurance Department intends to file a Section 1332 State Relief and Empowerment Waiver application with the federal government to promote stability in the state’s individual health insurance market with an expectation that plan year 2021 premiums will be reduced by approximately 15% over what they would have been otherwise.
With my big MLR Rebate project finally out of the way, I have a backlog of other write-ups, including several approved 2020 premium rate changes. First up is tiny Rhode Island.
As you may recall, back in July the Rhode Island insurance commissioner announced that the state was following New Jersey's model: They're reinstating the individual mandate penalty, and using the revenue from that to help fund their just-approved state reinsurance program to reduce unsubsidized premiums by 5-6 percentage points:
If approved, Rhode Island would have a $14.7 million reinsurance program for 2020 funded through the individual mandate penalty and federal pass-through funding. Rhode Island estimates a federal pass-through rate of 43 percent. Of the $14.7 million, the federal government would contribute less than half of the funds (about $6.4 million), and the state would contribute about $8.3 million.
Governor Raimondo’s proposed FY 2020 budget called for the creation of the Health Insurance Market Integrity Fund, which would make available reinsurance payments to health plans to reduce the burden of high cost claims on individual market premiums. According to insurer filings, the enactment of the Health Insurance Market Integrity Fund would reduce the individual market premium requests from 6.6% to -0.4% for BCBSRI and from 5.4% to 1.7% for NHPRI. These insurers’ pricing assumptions are subject to review and verification by OHIC. Table 1 shows the requested individual market rate increases with and without reinsurance.
REINSURANCE LOWERS HEALTH INSURANCE RATES FOR 2020
New Program Championed by Rosendale Leads to Double-Digit Rate Decreases in the Individual Market
HELENA, Mont. – State Auditor Matt Rosendale announced today that every health insurance plan sold on the individual market in Montana will have lower rates next year, largely due a new program that he’s championed for the past two years.
I wrote last month that Highmark BCBS, the sole individual market carrier operating in Delaware, has requested a 5.8% average premium reduction for 2020. In the press release from the state insurance department they noted:
It is important to note, that the proposed rate decrease is unrelated to Delaware’s intended submission of a 1332 Waiver to establish a reinsurance program. If the application process is successful, the actuarial consultant’s projections are correct, and the State of Delaware secures adequate funding, the waiver program may decrease rates by an additional 20%.
I feel kind of stupid posting this in the aftermath of not one, but two massacres in El Paso, TX and Dayton, OH (at least one of which was a clear case of white nationalist terrorism inspired and encouraged by Donald Trump), but I was bout 80% done with this last night and this is part of my job, so here it is.
Gov. Tony Evers today announced that 2020 rates on Wisconsin’s individual health insurance market will be 3.2 percent lower on a weighted average compared to 2019 rates. This encouraging news further demonstrates that the individual market is stabilizing and Wisconsin residents are able to access more affordable coverage options.
The rate decrease also highlights the positive impact of that the Wisconsin Healthcare Stability Plan (WIHSP), or the state’s reinsurance program, is having on the individual market. WIHSP was fully funded in the recently signed 2019-2021 state biennial budget. Without the WIHSP, rates in the individual market were expected to increase by 9 percent in 2020.
As I've explained before, Section 1332 of the ACA itself gives individual states the right to petition to make changes in how the law works in their state. The idea is that, as President Obama noted himself, if a state can come up with ways to make the ACA provide coverage which is at least as comprehensive to at least as many people as it already does, without increasing the federal deficit, go for it.
I wasn't expecting my analysis of Rhode Island's 2020 ACA premium changes to be of any particular interest; it's a small state with only two carriers offering individual market policies, after all, so there's not usually much to it.
Polis Administration Projects 18.2% Average Decrease in Premiums for Individual Health Insurance Plans in 2020
Reducing health care costs has been a top priority for Polis.
DENVER (July 16, 2019) – Today, the Colorado Division of Insurance (DOI), part of the Department of Regulatory Agencies (DORA), announced that for the first time ever, Colorado health insurance companies that sell individual plans (for people who do not get their health insurance from an employer or government program) expect to reduce premiums by an average of 18.2 percent (-18.2%) over their 2019 premiums, provided the reinsurance program is approved by the federal government. These are the health insurance plans available on the Connect for Health Insurance Exchange, the state’s health exchange made possible by the Affordable Care Act (ACA).
Dover, DE -- Highmark Blue Cross Blue Shield of Delaware (Highmark BCBS) has submitted its required annual rate filing to the Delaware Department of Insurance. After years of substantial increases, Delaware’s Marketplace has stabilized and premiums have decreased. Highmark BCBS, the only insurer continuing to offer insurance coverage in Delaware’s individual market, has proposed a 5.8% decrease for 2020. The proposed 2020 rate decrease will affect over 20,000 Delawareans.
The decrease comes after last year’s 3% rate increase and the Department’s decision to silver load. By applying the rate increase to silver level plans only, a practice known as ‘silver-loading,’ Delaware’s Marketplace received more federal subsidies, helping to assist in stabilizing the market and lowering premiums.
Insurance companies offering individual and small group health insurance plans are required to file proposed rates with the Montana State Auditor’s Department of Insurance for review and before plans can be sold to consumers.
What is rate review?
The rate review process, established by the Montana Legislature in 2013, does not give the Commissioner the authority to disapprove rates or prevent them from taking affect. It does give the commissioner the chance to review the factors insurance companies use in setting rates.
If the commissioner finds a rate increase to be excessive or unjustified, the insurer can voluntarily lower the rate increase. If the insurer decides to use the rate anyway, the commissioner will issue a public finding announcing that the rate is unjustified.