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:
This is a pretty minor update, but I'm trying to lock in all of the approved 2019 rate changes as they come in. Last month, South Dakota's two carriers, Avera and Sanford, posted requested rate increases which I thought were 2.6% and 10.0% at the time. I also estimated their relative enrollment at around 27,000 and 4,000 enrollees apiece for market share calculations, which gave a statewide average increase of around 3.5%.
I checked the South Dakota Insurance Division website again today, and it certainly looks like the filings have been approved by the state insurance regulators...however, when I double-checked the filings themselves, it looks like they were actually slightly lower than I thought: 2.5% and 9.7% respectively.
In addition, I was able to find the hard enrollment numbers for each...the total is pretty close to what I had it at (29,180 vs. 31,000), but the splut is quite different. Insetad of Avera still having an 87% market share, it looks ike the split is more like 63/37 this year. Since Sanford is requesting a significantly higher increase than Avera, that means the weighted statewide average is higher as well...around 5.2% instead of 3.5%.
South Dakota has two ACA indy market carriers, Avera and Sanford. The relative enrollment market shares are based on last year's numbers. The 14.4% #ACASabotage impact assumes 2/3 of the Urban Institute's projections to err on the side of caution.
THe average unsubsidized SD indy market enrollee pays $624/month this year; instead of that dropping by around $68/month, it's expected to increase by $22...for a total monthly difference of $90.
Assuming that's accurate, this means unsubsidized SD residents will be paying over $1,000 more apiece next year than they'd otherwise have to.
Needless to say, they found that the vast majority of the state insurance regulators and/or carriers themselves are pinning a large chunk (and in some cases, nearly all) of the rate hikes for next year specifically on Trump administration sabotage efforts...primarily uncertainty over CSR payment reimbursements and, to a lesser extent, uncertainty over enforcement of the individual mandate penalty.
South Dakota is another fairly straightforward state: Two carriers, around 31,000 total ACA-compliant enrollees on & off exchange. Neither filing indicates whether they're assuming CSR payments will be made or not, so I'm assuming they're based on them being paid.
As I noted when I crunched the numbers for Texas, it's actually easier to figure out how many people would lose coverage if the ACA is repealed in non-expansion states because you can't rip away healthcare coverage from someone who you never provided it to in the first place.
A proposal to expand a federal health insurance program for needy people could be off the table following the results of Tuesday's election.
The victory of Republican Donald Trump, who has called for a repeal of Obamacare, along with the increasingly conservative Republican make-up of the South Dakota state Legislature could thwart Gov. Dennis Daugaard's efforts to expand Medicaid in the state.
Daugaard for more than a year has worked with the Obama administration and the Indian Health Service to strike a deal, which stemmed the approval of a federal policy that allows the state to spend less on Medicaid-eligible Native Americans. And part of that bargain has been staked on South Dakota using the savings to cover an additional 50,000 South Dakotans under Medicaid.
Trump hasn't set a clear policy position on Medicaid expansion but has said he'd repeal the Affordable Care Act, though two of his closest allies, New Jersey Gov. Chris Christie and Indiana Gov. Mike Pence, have accepted Medicaid expansion.
Normally I post screenshots from the revised/updated SERFF filings and/or updates at RateReview.HealthCare.Gov, but it takes forever and I think I've more than established my credibility on this sort of thing, so forgive me for not doing so here. Besides, #OE4 is approaching so rapidly now that this entire project will become moot soon enough, as people start actually shopping around and finding out just what their premium changes will be for 2017.
The other reason I'm not too concerned about documenting the latest batch of updates/additional data is because in the end none of it is making much of a difference to the larger national average anyway; no matter how the individual carrier rates jump around in various states, the overall, national weighted average still seems to hover right around the 25% level.
Still, for the record, here's the latest...in four states (Iowa, Indiana, Maine & Tennessee) I've just updated the requested and/or approved average increases. In the other four (Massachusetts, Montana, North & South Dakota) I've added the approved rate hikes as well.
Wellmark Blue Cross and Blue Shield announced Tuesday that it will narrow its choices for individual Affordable Care Act plans in Iowa and will eliminate ACA individual plans in South Dakota altogether in 2017.
First, some clarification: Wellmark isn't on the exchange to begin with, and wasn't planning on joining it in SD next year, so this is a rare case of a carrier dropping their off-exchange individual market offerings. Since all of Wellmark's indy enrollees in South Dakota are paying full price, this one can't be blamed on APTC enrollees being sicker than average, etc.
Last month I noted that while South Dakota hadn't posted their ACA-compliant 2017 rate filings yet, they had posted their grandfathered/transitional filings, and decided to take a look at those. While GF/TR plans are down to a pretty nominal number in most states (and about half the states don't have any transitionals at all at this point), SD still has a huge portion of their individual market enrolled in them (over 1/3, from what I can tell).
Only 4 carriers appear to be participating in the ACA-compliant individual market in South Dakota next year: Aetna, Sanfrod, SD State Medical and Welmark. I only have the enrollment numbers for 3 of the 4, but the requested rate hike for the fourth one (Sanford) is pretty close to the average of the other three anyway, so it shouldn't really impact the overall average by much:
It's been nearly 2 weeks since the last update to my 2017 Requested Rate Hike project. While I've locked down the requested increases for 35 states and the District of Columbia, the remaining 15 states seem to be pretty quiet about their 2017 rate filings. Today, however, I'm able to fill in at least half of the puzzle for one state: South Dakota.
To the best of my knowledge, there are only 6 carriers offering policies on the SD indy market: Avera, DakotaCare (off-exchange only), Sanford, SD State Medical, Celtic and Wellmark BCBS. It's worth noting that DakotaCare is in the process of being bought out by Avera, but I'm not sure whether they'll be submitting separate filings or not.
A special session for Medicaid expansion will have to wait, Gov. Dennis Daugaard announced Wednesday.
After a weeks-long effort to lobby enough lawmakers to get the proposal approved in the Statehouse, Daugaard announced in a statement that he wouldn't call lawmakers back to Pierre.
Citing the upcoming presidential election that could result in substantial changes to the federal health insurance program for needy people, Daugaard said a special session was off the table.
“We have a good plan that would increase health care access at no additional state cost and guarantee that the federal government won’t shift its responsibility to pay for Native American health care to the state,” Daugaard said in a statement. “Still, I have heard from legislators that they would like more time to study this plan and in particular want to wait to consider the issue until after the presidential election. For that reason, I will not be calling a special session to take up this issue.”
Unlike the exchange QHP enrollments, which will always continue to be the heart and soul of this website (it's right there in the name, after all), I've kind of gotten away from trying to track Medicaid expansion on a granular level over the past few months. The main reason for this is that in many of the expansion states, they've simply maxed out on enrollees, and the numbers from week to week or even month to month are simply holding steady at this point.
South Dakota may join 30 other states in expanding its Medicaid program if federal officials approve a plan Gov. Dennis Daugaard is set to outline to the nation’s top health and human services administrator in Washington on Tuesday.
The Republican governor is meeting with Health and Human Services Secretary Sylvia Burwell to explain the plan, and the federal government has so far been more open to discussions than in the past, said Tony Venhuizen, chief of staff to Daugaard. The proposal, which is in its early stages, would make about 48,500 South Dakota residents newly eligible for the program.
The twist this time is that the Indian Health Service, which provides healthcare coverage for around 2 million Native Americans nationally, would be involved:
A few weeks ago, I crunched the (minimal) enrollment/rate numbers for South Dakota and came up with a fairly ugly weighted average rate hike of 27.4% (ouch). Being such a small state & population, there are only 5 insurance companies total offering individual policies either or off the exchange: Avera, Sanford, Welmark, Celtic and SD State Medical Holding, otherwise known as "DAKOTACARE" for some reason (and no, I refuse to capitalize the whole thing in the headline).
This evening Louise Norris informed me that DAKOTACARE has made 2 rather startling changes of plan: First, they're dropping off of the ACA exchange and will only be selling policies off-exchange...and instead of their previously-requested 18-20% rate hike, they've suddenly decided that they have to jack up rates an eyebrow-raising 63% next year.