...and believe me, it wasn't on purpose; I've simply been swamped the past couple of weeks with other stuff, and somehow I just never got around to writing anything up about it.
I should have, though. Everyone thinks the existential threat to the ACA was over back on July 28th, and now it's simply a matter of "stabilizing the market" and "stopping Trump from sabotaging Open Enrollment". For the most part this is true, but for whatever reason, Louisiana GOP Senator Bill Cassidy and South Carolina GOP Senator Lindsey Graham simply won't let it go already, and are insisting on trying one final, desperate Hail Mary play to squeeze through an ACA repeal/Trumpcare bill as the final seconds run out on the 2017 Fiscal Year (which ends September 30th).
Since I'm so late to the party on this and there's so little time to stop it, instead of my own explainer I'm going to simply crib a bit from former CMS head Andy Slavitt's USA Today column in which he gives the lowdown:
A week ago, Vox's Sarah Kliff reported that the Trump Administration was slashing the 2018 Open Enrollment Period advertising budget by 90% and the navigator/outreach grant budget by nearly 40%. As I noted at the time, the potential negative impact of these moves on enrollment numbers this fall--coming on top of the period being slashed in half, the CSR reimbursement and mandate enforcement sabotage efforts of the Trump/Price HHS Dept. and the general confusion and uncertainty being felt by the GOP spending the past 7 months desperately attempting to repeal the ACA altogether could be significant. In states utilizing the federal exchange (HealthCare.Gov), 2017 enrollment was running neck & neck with 2016 right up until the critical final week...which played out under the Trump Administration, which killed off the final ad/marketing blitz.
Result? A 5.3% total enrollment drop (or 4.7% if you don't include Louisiana, which expanded Medicaid halfway through the year) via HC.gov, while the 12 state-based exchanges--which run their own marketing/advertising budgets--saw a 1.8% increase in total enrollment year over year.
Michiganders purchasing health insurance through the federal marketplace will see an average rate increase of 27.6 percent in 2018, the Michigan Department of Insurance and Financial Services announced Friday.
One reason for the big increase: Uncertainty over whether President Trump will continue to fund Cost-Sharing Reduction payments, which subsidize plans for low- and moderate-income households.
Anthem on Wednesday continued reducing its Obamacare business, as the big insurer said it will cut in half the number of counties in Kentucky where it sells individual health plans next year.
Virginia was the very first state whose 2018 rate filings I analyzed, way back in early May. At the time, the initial filings amounted to 9 carriers on the individual market with an average rate increase request of around 30%. At the time I hadn't started distinguishing between "with CSR payments" or "without CSR payments", so I don't really know which scenario that 30% reflected; it was probably a mix of both depending on the carrier. 61,000 Aetna enrollees would have to shop around for a new carrier since they had previously announced they were pulling out of the individual market.
Up at the top of the site is a big yellow button leading directly to the ongoing 2018 Rate Hike project. Let's face it, though: It's an awful lot of updates to scroll through. In addition, now that we're past the (extended) rate filing deadline, I've been able to make a lot of updates over the past few days (shoutout to Louise Norris, who did much of the grunt work on these).
As of today (September 6th), I now have average requested 2018 rate changes for the individual market across all 50 states + DC, and have made updates/corrections to several of these.
More importantly, I also now have approved 2018 rate changes for 6 states. They only represent around 9% of the population, though, so I wouldn't focus very much on the "national average" for the approved states yet; that will jump around a lot as more states are added to the mix, and likely won't start to settle in until at least half the states are included.
Having said that, here's what things look like as of today:
(sigh) Colorado's state insurance division just released their approved 2018 rate increases (busy day!), and the situation appears to be similar to Maine: The average requested rates which I thought already assumed no CSR reimbursements appear to have assumed CSRs would be paid after all:
Division of Insurance approves health insurance premiums for 2018
Commissioner: Measures to stablize market for 2018 must happen by Sept. 30
DENVER (Sept. 6, 2017) – The Colorado Division of Insurance (DOI), part of the Department of Regulatory Agencies (DORA), has approved the individual and small group health insurance plans for 2018. Average premium changes within each market - individual and small group - as well as the average change for each insurance company are listed below.
The state of Maine's insurance regulatory agency has announced the approved 2018 individual market rate hikes for the three carriers operating in the state. Louise Norris beat me to the punch:
Regulators in Maine published rate proposals for the three Maine exchange insurers in June, and finalized the rates in early September. Insurers proposed two sets of rates: one that assumes cost-sharing reduction (CSR) funding will continue, and another that assumes the federal government will not fund CSRs in 2018.
The Maine Bureau of Insurance initially rejected all three insurers’ rate proposals on August 10, and asked them to submit new rates. The revised rate filings were then approved on September 1. These average approved rate increases all assume that CSR funding will continue in 2018:
Vermont was one of the first states I analyzed back in the late spring; obvoiusly a lot has changed since then, so I updated/revised my analysis of their requested rate hikes for 2018 a couple of weeks ago, with requested average increases of 11.9% if CSR payments are made or 21.6% if they aren't.
Yesterday, Louise Norris gave me a heads up that the Vermont regulators have issued their approved rate increases for the two carriers operating on the individual and small group markets in the tiny state. This makes Vermont the 4th state to announce their approved rates for next year, joining Oregon, Maryland and New York.
Nevada is the final state to post their requested rate hikes for 2018 (or at least they're the last one I tracked down, anyway). I've now done at least a rough analysis of all 50 states + DC, and while some of the data is a bit outdated (remember, I started doing this back in late April/early May), most of it should still be fairly close to the present situation...at least in terms of requested rate hikes.
In Nevada, after much concern that a bunch of rural counties wouldn't have any exchange carriers at all, Centene stepped in to cover them. They aren't listed in the table below, but since I believe they're new to the state, that shouldn't matter in terms of rate increases since there's no base rates to compare against anyway.
