Rhode Island

When I last checked in on Rhode Island's 2016 rate increase status, the three companies operating in the state (BCBSRI, Neighborhood and UnitedHealthcare) had requested hikes of 7%, 8.6% and 11% respectively. There was no off-exchange enrollment data, but the exchange-based market share breakdown was roughly 48.5% / 48.5% / 3%. This meant a requested average hike of around 7.9%.

A week or so ago, the approved rate hikes were released for Neighborhood and UHC, along with total enrollments (on+off exchange) for BCBS:

Still unresolved is how much Blue Cross and Blue Shield of Rhode Island may raise rates for its individual plans, which cover about 25,000 people. The nonprofit insurer initially requested an 18-percent increase, but no decision has yet been made because, by law, its rate hike requests are reviewed in a separate process that reserves a key role for the state's attorney general.

I was kind of hoping that this morning's Gallup uninsured rate news would include a monthly update for July; instead, it only runs through the end of June, the same quarterly survey results that they released a month ago. Then again, things probably didn't change much in July.

Instead, this time they've broken the numbers out by state:

WASHINGTON, D.C. -- Arkansas and Kentucky continue to have the sharpest reductions in their uninsured rates since the healthcare law took effect at the beginning of 2014. Oregon, Rhode Island and Washington join them as states that have at least a 10-percentage-point reduction in uninsured rates.

Louise Norris has done the heavy lifting for me regarding Rhode Island's 2016 rate change requests. Then again, there's only 3 companies operating on the exchange anyway (and I don't see any other companies operating off-exchange only, so I assume that's it for the state's individual market):

Of the three carriers that offer individual plans in HealthSource RI, only one –UnitedHealthcare of New England – shows up on the rate review tool that HHS is using to publish proposed rate hikes of ten percent or higher.  United is requesting an average rate increase of about 11 percent for their Compass individual plans.

Blue Cross Blue Shield had also initially proposed weighted average rate hikes of 11 percent for their individual market plans in RI, but in early July, the carrier revised their projection to a weighted average rate increase of just 7 percent.  The lower rate is partially due to the fact that in the FY 2016 budget (see below), the HealthSource RI premium fee is lower than initially proposed.

The last official enrollment update for Rhode Island was 31,513 people as of 2/23/15, of which 30,001 had paid their first monthly premium at the time.

On the one hand, that makes it look like an amazing 95% payment rate; however, RI also "pre-purged" unpaid enrollments which missed the payment deadline prior to officially reporting them, so their payment rate actually ended up being more like 91% (ie, 30K out of around 33K total selections).

As of July 3rd, the QHP selection total for RI stood at "over 36,000":

HealthSource RI has enrolled over 36,000 Rhode Islanders in 2015 healthcare coverage to date. Some Rhode Islanders may be eligible for a special enrollment period (outside of open enrollment) during which they can get coverage because of qualifying life-change events (such as a change in family status, loss of insurance, and certain hardships).  More information about who qualifies for a special enrollment period is available at HealthSourceRI.com.

You don't hear a whole lot about the other ACA healthcare exchange system, the Small Business Health Options Program (SHOP, although it should really be "SBHOP" which looks like a typo). In fact, to my knowledge, the HHS Dept. has never said a peep about the SHOP numbers in any of their official reports or press releases. There's a reason.

Rhode Island just made an announcement about their SHOP program. RI only has a total population of just over 1.05 million people anyway. so 3,500 people enrolled in the state's Small Business exchange policies actually isn't too bad, really (for comparison, this would be the equivalent of California enrolling around 128,000 people in theirs).

The impending King v. Burwell Supreme Court decision will cast an even larger shadow over the ACA over the next 2 months (the decision is expected to be announced in June), as exchanges in 6 of the 14 states running their own (State-Based Marketplaces, or SBMs) are at risk of either being abandoned, dissolved or otherwise moved over to the federally-run Healthcare.Gov exchange:

The federal government is threatening to take over Hawaii's health insurance exchange within months and has restricted grant money to support operations of the Hawaii Health Connector.

Jeff Kissel, the Connector's executive director, told lawmakers at a briefing Thursday that if the exchange created by the Affordable Care Act does not get state funding soon, the federal government will abolish Hawaii's marketplace and run it directly.

On the surface, this story may seem pretty minor in the scheme of things:

Rhode Island's ACA exchange hasn't suffered from the technical glitches which are still causing problems for some states (particularly Vermont and Minnesota), but HealthSource RI does have one major problem to deal with: Funding. It's a small state with a smaller customer base for the exchange; 31,500 enrollees isn't a lot of people to cover the costs. As a result, the Governor of Rhode Island has come up with a healthcare policy tax idea which is being batted around.

The article goes into the pros and cons of the tax as opposed to simply dropping the exchange altogether and moving to Healthcare.Gov. Aside from the biggest and most obvious downside of doing so (King v. Burwell), it's also not certain that making the move would actually save any money, since HC.gov still takes some bucks to run:

Neither option is free.

Mazel Tov to HealthSourceRI for being the first of the state-based exchanges to release their full 2015 Open Enrollment Period (with #ACAOvertime included) results. HC.gov released their collective total yesterday, but haven't broken it out by state yet; Kentucky released data through 2/19 but their extension period isn't over until Saturday; and I have a rough estimate for Massachusetts, but they won't release their official tally until tomorrow.

Meanwhile, here's Rhode Island's final count:

PROVIDENCE – HealthSource RI (HSRI) has released enrollment data, certain demographic data and certain volume metrics through Monday, February 23, 2015, for Open Enrollment and the Special Enrollment Period (due to previous weather closings at the contact center and walk-in locations).

It's a long press release, but here's the latest update out of Rhode Island (which has a FULL extension/overtime policy through 2/23).

The grand total: 30,744 QHPs, of which 27,487 have paid their first premium (89.4%). The payment rate has gone down because a huge number of those 30,744 just enrolled in the past week or so, and thus their payments aren't due for another week yet.

SHOP enrollments now stand at 3,349.


Posted on February 18, 2015 | By HealthSource RI

PROVIDENCE – HealthSource RI (HSRI) has released enrollment data, certain demographic data and certain volume metrics through Sunday, February 15, 2015, the last day of Open Enrollment.

I've confirmed that Rhode Island's weather-induced enrollment extension is indeed state-wide and is of the "full" variety (ie, people can start the application process, not just finish it), through February 23rd. This is exactly the same policy that the Massachusetts exchange announced the other day.

Also, a late-breaking extension announced from Maryland.

11:45pm: OK, add the DC exchange to the pile.

9:00am 2/16/15: OK, HHS/CMS has clarified the specifics for the 37 Healthcare.Gov states.

11:50am 2/16/15: Idaho's policy took some work to decipher...

2:24pm 2/16/15: ...and Minnesota...