Texas

Rate Changes

As I noted last night, thanks to the federal Rate Review website finally being updated to include the final, approved 2022 rates for both the individual and small group markets in all 50 states (+DC), I've been able to fill in the missing data for my annual ACA Rate Change Project.

As I note there, the overall weighted average looks like it'll be roughly +3.5% nationally.

Normally I write up a separate entry for both the preliminary and approved rate changes in each individual state, but it seems like overkill to create 14 separate entries at once. Besides, in many of these states there's been few if any changes between the preliminary and approved rate changes.

Texas

Texas' annual health insurance rate filings are kind of a mixed bag in terms of transparecy. Hardly any of the carriers have Uniform Rate Review Template (URRT) forms or Rate Filing Justification Form Part II available (these are the documents which generally include the actual number of people enrolled in the policies for each market for that insurance carrier), and the Actuarial Memorandum (Part III) is heavily redacted for most of them, making it very difficult to lock in the actual enrollment numbers.

On the other hand, a few of them do offer one or both of the former documents, and in a few cases I was able to get the policyholder figures via the SERFF database. I'm operating on the assumption that each individual market policy has roughly 1.5 covered lives apiece on average.

Unfortunately, without having even that estimate available for half the carriers offering policies in Texas, I can't run a weighted average increase (it comes to +4.9% using what I have available), so I'm left (once again) with an unweighted average of around +1.5% on the individual market and +6.1% for small group policies.

Texas

I've once again relaunched my project from last fall to track Medicaid enrollment (both standard and expansion alike) on a monthly basis for every state dating back to the ACA being signed into law.

For the various enrollment data, I'm using data from Medicaid.gov's Medicaid Enrollment Data Collected Through MBES reports. Unfortunately, they've only published enrollment data through December 2020. In most states I've been able to get more recent enrollment data from state websites and other sources. I'm using estimates based on raw data from the Texas Dept. of Health & Human Services for January 2021 and beyond.

Texas is one of 12 states which still hasn't expanded Medicaid eligibility under the ACA (13 if you include Missouri, whose voters expanded the program last year...but which the state legislature refuses to fund)...and by far the largest.

Texas

 Now that I've developed a standardized format/layout & methodology for tracking both state- and county-level COVID vaccination levels by partisan lean (which can also be easily applied to other variables like education level, median income, population density, ethnicity, etc), I've started moving beyond my home state of Michigan.

Here's Texas:

NOTE: The CDC lists ~110,000 Texas residents (1.1% of the total fully vaccinated) whose county of residence is unknown.

Gummy Penis

March 2, 2021:

The ACA's language didn't account for the possibility that some states might not expand Medicaid, which is why the lower-end range of exchange plan subsidy eligibility starts off at 100% FPL...

Unfortunately, those earning less than 100% FPL are still stuck without any viable options besides either "going bare" and praying they don't get sick or injured or possibly buying a junk plan of some sort. According to the Kaiser Family Foundation, there's around 2.2 million Americans still caught in the "Medicaid Gap", where they don't qualify for Medicaid but don't earn enough to be eligible for subsidized ACA exchange policies (Kaiser estimates another 1.8 million uninsured adults in these states in the 100 - 138% "overlap" cateogory, plus around 356,000 who are eligible for Medicaid but still haven't enrolled for one reason or another).

Gold Bars

NOTE: This is an updated version of a post from a couple of months ago. Since then, there's been a MASSIVELY important development: The passage of the American Rescue Plan, which includes a dramatic upgrade in ACA subsidies for not only the millions of people already receiving them, but for millions more who didn't previously qualify for financial assistance.

Much has been written by myself and others (especially the Kaiser Family Foundation) about the fact that millions of uninsured Americans are eligible for ZERO PREMIUM Bronze ACA healthcare policies.

I say "Zero Premium" instead of "Free" because there's still deductibles and co-pays involved, although all ACA plans also include a long list of free preventative services from physicals and blood screenings to mammograms and immunizations with no deductible or co-pay involved.

Much has been written by myself and others (especially the Kaiser Family Foundation) about the fact that millions of uninsured Americans are eligible for ZERO PREMIUM Bronze ACA healthcare policies.

I say "Zero Premium" instead of "Free" because there's still deductibles and co-pays involved, although all ACA plans also include a long list of free preventative services from physicals and blood screenings to mammograms and immunizations with no deductible or co-pay involved.

If you have a fairly healthy year, you really could go the entire year without paying a dime in healthcare costs while still taking advantage of many of these free services, and also having the peace of mind that in a worst-case scenario, at least you wouldn't go bankrupt. Not perfect, but a lot better than going bare especially since you wouldn't pay a dime in premiums.

 CMS Offers Comprehensive Support to the State of Texas to Combat Winter Storm 

The Centers for Medicare & Medicaid Services (CMS) announced today that efforts are underway to support Texas in response to severe winter storms that have affected the state over the past several days.  On February 17, 2021, Health and Human Services Acting Secretary Norris Cochran declared a public health emergency (PHE) for Texas retroactive to February 11, 2021. CMS is working to ensure hospitals and other facilities can continue operations and provide access to care despite the effects of the storm. 

Below are key administrative actions CMS is taking in response to the PHE declared in Texas:

Waivers and Flexibilities for Hospitals and other Healthcare Facilities: CMS has already waived many Medicare, Medicaid and CHIP requirements for facilities because of the pandemic. 

Back in July I posted a partial look at the preliminary 2021 ACA market landscape for Texas. I only had data for about 1/3 of the carriers at the time, so it was more of an overview than anything.

Now I have most of the data needed to analyze the individual market for 2021: Assuming no major changes in the approved rates, carriers are averaging around a 7.4% premium increase next year. This is actually unusually high for 2021 so far...other states are averaging less than 2% overall.

Most of the rate hike seems to be caused by Celtic/Ambetter ("Superior Health Plan"), which holds 1/3 of the entire market and is raising rates by nearly 12%. Blue Cross Blue Shield, which has another 36% market share, is only raising rates 3%, while the third and fourth largest carriers in the market, Molina and Oscar, are raising rates by 5.3% and 14.7% respectively.

There's also a couple of misleading numbers--both divisions of "Scott & White" are massively DROPPING their premiums for 2021, by 33% and 54%...but they have fewer than 2,000 people enrolled total to begin with; make of that what you will.

Unfortunately, it looks like only some of the 2021 ACA individual market premium rate filings have been uploaded to the SERFF database as of today, so I'm unable to calculate anything even close to an accurate weighted average. There are, however, several noteworthy items on the TX market:

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