*(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.
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:
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.
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.
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.
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.
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.
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.
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.
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.”