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:
Just hours after explaining what a dramatic impact the nearly-flat average 2020 premium changes are going to have on this year's (and next year's) Medical Loss Ratio rebate payments, I've discovered that rates are going to be increasing even less than I thought nationally.
Back in late May, Virginia was one of the first states to post their preliminary 2020 premium rate filings. At the time, the 10 carriers participating in VA's individual market (one of which is new for 2020) were asking for average increases of 2.9% statewide:
Virginia is traditionally the first state to release their preliminary individual (& small group) market healthcare policy rate changes, but this year the state insurance regulatory body delayed the initial deadline by a couple of weeks. As a result, three other states (Maryland, Vermont and Oregon) beat Virginia to the punch this year.
The extended VA deadline passed last week, however, and so I'm now able to dig up the preliminary 2020 rate filings for the ACA market. It's important to remember as always that these are preliminary requests only; some of them are bound to change at least once between now and late September, when the final rate changes are locked in and the contracts are signed for the 2020 calendar year (and Open Enrollment Period).
Virginia Governor Ralph Northam has been out of the national news for the past month or so, keeping a low profile since the media frenzy over the "med school blackface photo" debacle subsided. Rightly or wrongly, in the end, in spite of pretty much everyone under the sun demanding that he resign, he stuck it out and outlasted the scandal by simply...not.
He isn't up for reelection (and in fact under Virginia law he can't run again anyway), he didn't actually commit any crimes or anything else impeachable, so it sounds like the state has pretty much just sort of accepted that he's gonna stick it out for another couple of years. In fact, according to this article in the Virginian-Pilot, he seems to have regained some of his pre-scandal stature:
Two months after a blackface photo in an old yearbook nearly ended the political career of Virginia Gov. Ralph Northam, his life seems mostly back to normal.
Last fall, I estimated that perhaps 85,000 of those newly eligible to enroll in Medicaid would actually be "cannibalized" from the existing ACA exchange enrollee population...and sure enough, when the 2019 Open Enrollment numbers were posted, exhange enrollment in Virginia was down by 72,000 people, putting them dead last nationally in terms of year over year performance (down 18% from 2018).
Unfortunately, without an income demographic breakout, there's no way of being certain how much of that dropoff was due to Medicaid expansion as opposed to middle-income enrollees simply choosing to drop their coverage.
Today, however, Virginia state delegate Danica Roem posted the following update, which includes a link to a very nifty interactive graphic Medicaid expansion dashboard:
Governor Northam Announces Medicaid Expansion Hits Milestone with More Than 200,000 Enrolled
Virginians can apply at any time of the year
RICHMOND—Governor Ralph Northam announced Friday that more than 200,000 Virginia adults are now enrolled and will have health coverage starting January 1. The achievement marks a major milestone in the Medicaid expansion initiative approved last summer.
“This bipartisan initiative has empowered men and women across the Commonwealth to take an active role in improving their health,” said Governor Northam. “The historic response from our citizens demonstrates the need for access to health coverage that will benefit our families, our communities and Virginia’s economy. I encourage uninsured individuals to learn more about this new health coverage opportunity and to apply today.”
SNAP recipients and parents of children with Medicaid coverage can use three-question application until January 4
The new coverage is available to men and women ages 19 through 64 who are not eligible for Medicare and who meet income requirements, which vary by family size. For example, a single adult with an annual income at or below $16,754 may be eligible for coverage. An adult in a three-person family with a total household annual income at or below $28,677 may be eligible.
SNAP recipients and parents whose children are currently receiving Medicaid coverage have the opportunity to use a short-form application to sign up if they do so by January 4, 2019. These individuals were notified by letter earlier this fall, and a follow-up postcard was recently mailed to potentially eligible adults in these categories.
With all the attention being paid to the midterm elections causing ACA Medicaid expansion to be passed in Utah, Nebraska and Idaho (while also now being at risk in Alaska and Montana), I've kind of lost track of the situation in Virginia, where it was expanded last May to over 400,000 Virginians.
Less than two weeks after Virginia opened registration for its expanded Medicaid program, officials say they’ve already drawn thousands more applicants than initially anticipated.
The state had expected the new program to enroll 300,000 over the next year and a half. They now expect that number to reach 375,000. The new estimates won’t alter the total expansion population, which the state has said will be about 400,000.
By early September, it was clear that Trump would indeed be cutting off CSR funding. With just a few weeks left before the final deadline to sign 2018 ACA exchange contracts, Optima suddenly announced that they were not only jacking up rates a whopping 81%, they were also pulling out of a large chunk of the state, leaving large areas at risk of "going bare" without any ACA carriers whatsoever.
...Then, on September 14, with just days to spare and thanks to what I assume were some pretty intense backroom deals being made, Anthem suddenly announced that they were back in the game after all!
Last year, Virginia residents experienced massive amounts of heartburn and ulcers as two major insurance carriers, Optima (Sentara Health) and Anthem (HealthKeepers) played musical chairs with both their 2018 rate filings and which areas of the state they offered plans on.
In May 2017, things didn't look too bad: Both Anthem and Optima were available in fairly large chunks of the state, and while Anthem wanted to raise rates an ugly 38% on average, Optima was only looking to increase rates by around 10-11%.
Hot on the heels of Anthem's announcement that they're significantly expanding their ACA market coverage throughout Virginia comes another piece of welcome news:
Gov. Ralph Northam’s administration will convene a new work group on Monday to consider options to stabilize soaring premiums in Virginia’s health insurance market.
The Virginia Market Stability Group will consider a wide range of options to lower insurance premiums expected to average more than $833 a month next year, making coverage unaffordable to people who don’t qualify for federal subsidies for premiums or out-of-pocket expenses in the marketplace established by the Affordable Care Act.
...But one option could trump all others — a state budget plan to request a federal waiver for a “re-insurance” program in Virginia that would help defray the costs for the most expensive patients and relieve the expense for others by lowering the risk.
Members of local advocacy group Charlottesville For Reasonable Health Insurance had provided testimony at the Virginia General Assembly and organized an email campaign, helping to ensure passage of the bill through the legislative session. Introduced by Sen. Creigh Deeds and effective July 1 2018, SB672 will allow self-employed people to take advantage of the much more affordable health plans in the small group business marketplace, without having to hire employees.
...Charlottesville and surrounding counties (Albemarle, Green, Fluvanna) have by far the most expensive healthcare premiums in the nation in 2018. Rates more than tripled for consumers buying coverage on the ACA Individual Exchange, making comprehensive insurance unaffordable for people who do not qualify for subsidy assistance. A typical family of four is being charged $3000 per month for high deductible plans.
Apparently it still has to be kicked back to the state Assembly for a final vote, but it appears to be a done deal at last:
The Virginia Senate just passed Medicaid expansion, which three Republicans joining all 19 Democrats voting in favor. The House, which already passed expansion, has to vote again. We'll have more later, but here's the backstory. https://t.co/ldFEb5vYyt
Elections have consequences: To get enough GOP votes, this Medicaid expansion includes a work requirement and premiums above the poverty line, which will cut into coverage gains. Virginia must continue the fight.