Rhode Island

*(Yes, I know, the District of Columbia isn't actually a state, and Vermont's mandate is...well, read on...)

As the 2020 Open Enrollment Period rapidly approaches (it starts November 1st nationwide...except for California, where open enrollment is starting on October 15th), it's time to start getting the word out about some important things to keep in mind this fall.

One of the most critical things to remember for residents of California, the District of Columbia, Massachusetts, New Jersey, Rhode Island and Vermont is that each of these states* has reinstated an individual healthcare coverage mandate law/ordinance to replace the federal ACA mandate penalty which was zeroed out by Congressional Republicans back in December 2017. This means that if you live one one of them, unless you receive an affordability, hardship or other type of acceptable exemption, you'll be charged a financial penalty when you file your state/district taxes for 2020 in spring 2021 if you don't have qualifying healthcare coverage.

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.

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:

I noted last month that Rhode Island was the latest state to put in for an ACA Section 1332 reinsurance program waiver:

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.

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.

When I last checked in on the Ocean State (seriously...that's their official slogan for whatever reason), I had noted that the state Senate had passed a bill (2019-S 0738A) which, if signed into law, would lock in most of the ACA's "Blue Leg" protections, including guaranteed issue, community rating, removal of annual/lifetime coverage caps and so forth.

Last week I reported that California and New Jersey were pushing through a long list of "Blue Leg" ACA protections at the state level; it turns out that Rhode Island has been quietly pushing through their own suite of ACA protection legislation as well! This is from May 16:

PROVIDENCE — The state Senate approved legislation Thursday intended to protect Rhode Islanders’ access to health insurance in the face of threats to the federal Affordable Care Act.

The legislation was sponsored by Sen. Joshua Miller, D-Cranston, chairman of the Senate Health and Human Services Committee. The House version of the bill was sponsored by Rep. Joseph M. McNamara, D-Warwick,  chairman of the House Health, Education and Welfare Committee. The bill aims to ensure that the standards of the Affordable Care Act remain in effect in Rhode Island, even if the courts or Congress were to eliminate the federal laws that created it.

HealthSource RI enrollments up by nearly 2,000 customers as RI’s uninsured rate reaches all-time low

Feb 25, 2019

  • According to the latest Rhode Island’s Health Information Survey, only 3.7% of Rhode Islanders were uninsured in 2018, down from 4.2% in 2016.
  • HealthSource RI’s individual and family enrollments increased by 1,849. This Open Enrollment, 32,486 customers enrolled and paid compared to 30,637 last year.

The "...and paid" caveat is important. Last month HealthSource RI reported 34,533 QHP selections after the 2019 OEP wrapped up, so that's an impressive 94% paid/effectuated rate. For comparison, last year 30,637 paid out of 33,021, or 92.8%, so they've improved on that front as well.

As part of her proposed 2020 annual budget, Rhode Island Governor Gina Raimondo has included an item of particular interest to those following the ACA:

Health Care Access and Affordability

State government plays a critical role in today’s health care system. Every policy decision we make has an impact on the individuals, children and families who need care. The Governor’s FY20 budget proposal builds on this momentum, preserving vital ACA protections that promote market stability and help to keep uninsured rates low. There are no eligibility cuts or broad-based benefit impacts proposed.

...Market Stability and Reinsurance Initiative

Rhode Island may be a tiny state, but they just became the 11th state to officially surpass their 2018 Open Enrollment Period total, and the 4th state-based exchange to officially do so...when they still had one day left to go:

EAST PROVIDENCE, R.I. (WPRI) — Rhode Islanders have just a few hours left to obtain health insurance through the state.

The deadline to sign up for and renew coverage for 2019 is Monday, Dec. 31.

The state's health insurance marketplace, HealthSource RI, plans to keep its call and walk-in center open until 7 p.m. Monday.

The center is located at 401 Wampanoag Trail in East Providence and the hotline is 1-855-840-4774.

Rhode Islanders have until midnight Monday to sign up for coverage online through HealthSource RI's website.

"Enrollment is up from last year, which we're very excited about, so that to us is a sign that the ACA is working in Rhode Island, and everybody is understanding the value of having health coverage," HealthSource RI COO Meg Ivatts said.

This isn't an official update, but it's all I have for now. Back on November 29th, the Providence Business News reported that HealthSourceRI, Rhode Island's ACA exchange, was reporting 31,000 QHP selections (including auto-renewals).

Saturday, in response to the insane #TexasFoldEm judicial ruling, RI Governor Gina Raimondo was quoted for a response; the article at WPRI.com states that:

More than 32,000 people have signed up so far for coverage beginning January 2019, according to HealthSource RI.  

"This does not change anything about coverage people currently access through HealthSource RI, nor does it change our current open enrollment period," Sherman said.

Sherman encourages those who need health insurance to sign up before open enrollment ends.  You have until December 31st, although officials recommend you sign up before the 23rd.

HealthSourceRI hasn't posted any official press release yet, but this story by Rob Borowski in Providence Business News covers all the basics:

PROVIDENCE — HealthSource RI, the state’s health insurance exchange, reports 31,000 people have signed up for health care coverage about a month into the open enrollment period for the 2019 plan year ending Dec. 23, 3,600 enrollments ahead of where they were at this point last year.

Last year at about this time during open enrollment, HealthSource RI had counted about 27,400 people enrolled for health insurance through the exchange, according to HealthSource RI Director Zachary W. Sherman.

Sherman said the agency has seen many people renewing existing coverage either manually or automatically.

“We’re pleased with where we are with sign-ups,” Sherman said.

It’s Time to Start Shopping for Health Insurance

HealthSource RI offers the cheapest insurance in RI, nearly half of customers pay less than $100 per month for coverage

EAST PROVIDENCE, RI (October 29, 2018) – Rhode Islanders: it’s time to put health insurance on your shopping list. Individuals and families looking for coverage starting January 1, 2019 should pick and pay through HealthSource RI by December 23.

“HealthSource RI has the cheapest health insurance in Rhode Island, and I’m proud of the work we’ve done to keep costs as low as possible,” said Governor Raimondo. “I urge Rhode Islanders looking for coverage to explore HealthSource RI’s quality, affordable options.”

And now it’s easier than ever to pick the medical and dental coverage from Rhode Island’s leading insurance companies. Rhode Islanders can visit HealthSource RI’s new and improved English and Spanish websites at HealthSource RI.com, plug in some basic information, and quickly compare their options and estimate their savings. 

via U.S. News & World Report:

Later Wednesday, [Democratic Governor Gina] Raimondo held her own news conference to sign an executive order that, among other steps, directs the state to seek to codify in state law protections for people with preexisting conditions, dependents up to age 26, prescription drug benefits and maternity coverage in case federal action is taken to weaken the Affordable Care Act.

Rhode Island has one of the highest insured rates in the country, and Raimondo said she was defending "Rhode Islanders' access to high-quality, affordable health coverage."

I'm not quite sure what an executive order has to do with codifying ACA protections into law, since that's really up to the state legislature to do, but I guess it at least kicks their butts into gear?

This is also refreshing to hear from a Republican challenger:

Rhode Island is kind of an interesting state this year. The smallest state geographically and one of the smallest population-wise, they only have two carriers offering individual market coverage: Blue Cross Blue Shield and Neighborhood Health Plan. Way back in May both carriers submitted their preliminary 2019 ACA policy rate increase requests, averaging around 9.7% overall. What's most noteworthy is that unlike most other states, both carriers are mostly blowing off 2018 ACA sabotage factors like mandate repeal and #ShortAssPlans. Blue Cross isn't adding anything to account for the negative risk pool impact, while Neighborhood (which holds slightly more than half of the market share) is only tacking on about 2% in response.

This Just In...

State’s Market Stability Workgroup Recommends Immediate Action to Protect Rhode Islanders from Federal Threats to Health Insurance Access and Affordability

Posted on June 27, 2018 | By HealthSource RI

EAST PROVIDENCE, R.I. (June 27, 2018) – Rhode Island must act “without delay” to protect consumers from rising health coverage costs brought on by federal policy changes according to a report issued to Governor Raimondo by the state’s Market Stability Workgroup.

“People representing a wide variety of viewpoints engaged in lively discussions over the course of 8 weeks,” said Workgroup co-chair Bill Wray, Chief Risk Officer at the Washington Trust. “The fruits of those discussions are in this report. All of us – consumer advocates, business groups, health insurers and providers – were able to broadly agree on how best to protect Rhode Island’s insurance markets.”

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