Virginia

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%.

When I first ran the preliminary 2019 ACA individual market rate filings for Virginia way back in May, I concluded that the average premium increase will be around 13.4%. However, a lot has changed since then.

For one thing, Virginia expanded Medicaid to 400,000 low-income residents, which should help improve the ACA risk pool and in turn knocked the average rate increase down by 2.2 points, to around 11.3%.

For another, Anthem made a last-minute decision to expand their coverage areas in the state dramatically, which also provides much-needed competition for Optima in the Charlottesville area, among others.

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.

UPDATE: As noted in the comments below, it looks like Anthem won't be expanding to cover the entire state after all. Even so, this is a major improvement in the situation.

Every year, Virginia is the first state out of the gate with their preliminary healthcare premium rate changes for the following year, posting the initial rate requests in early May. For 2019, it originally looked like the carriers were asking for a statewide average increase of 15.2%, but I later corrected this to 13.4%.

However, these were just preliminary numbers. The requests still have to go through the rate review process, and the carriers often make other changes as well before the final deadlines pass.

Several weeks ago I wrote about a bit of a bombshell development in Virginia:

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

— Jeffrey Young (@JeffYoung) May 30, 2018

There's one downer, of course:

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.

— Topher Spiro (@TopherSpiro) May 30, 2018

Two big developments (or in one case, a lack of development) out of Virginia this evening.

First: Just yesterday I was noting that it looked as though after 8 years, Virginia's state legislature might finally be going ahead and expanding Medicaid under the ACA as soon as today:

The stage is set for a showdown in the Virginia Senate on Tuesday over a budget compromise negotiated by Senate Finance Co-Chairman Emmett Hanger, R-Augusta, and House Appropriations Chairman Chris Jones, R-Suffolk, to expand the state’s Medicaid program and pay for the state’s share through a new tax on hospital revenues that also would boost Medicaid payments for inpatient provider care.

Unfortunately...that didn't happen:

Governor Northam Statement on Virginia Senate Budget Process

Several stories like this throughout Monday afternoon/evening (via Michael Martz of the Richmond Times-Dispatch:

The stage is set for a showdown in the Virginia Senate on Tuesday over a budget compromise negotiated by Senate Finance Co-Chairman Emmett Hanger, R-Augusta, and House Appropriations Chairman Chris Jones, R-Suffolk, to expand the state’s Medicaid program and pay for the state’s share through a new tax on hospital revenues that also would boost Medicaid payments for inpatient provider care.

(The article goes into all the other non-Medicaid related stuff in the budget as well, of course, although some of it is obviously healthcare-related.)

Having a doctor holding elected office is kind of hit or miss (former HHS Secretary Tom "Fly Me!" Price was an orthopedic surgeon, for instance, while Rand "Kneel before Aqua Buddha!" Paul is supposedly a "self-certified" opthamologist), but once in awhile it can be a very good thing.

Case in point: Ralph Northam, the new Governor of Virginia, a former Army doctor and pediatric neurologist, who just formally vetoed not one, not two, but four different GOP-passed healthcare bills, each of which would have further weakened and damaged the ACA individual market risk pool:

RICHMOND—Governor Ralph Northam today vetoed Senate Bills 844, 934, 935, and 964, which would put Virginians at risk of being underinsured, result in rapidly increasing Marketplace premiums, and undermine key protections in the Affordable Care Act. Governor Northam remains committed to expanding health care for nearly 400,000 uninsured Virginians, return millions to the state budget, and reduce Marketplace premiums. The Governor’s full veto statements are below.

Holy smokes. A huge shout-out to Esther F. for the heads up on this. I have no idea how this story slipped under my radar the past few months:

Northam signs healthcare bill to provide relief to Virginia entrepreneurs
Published Wednesday, Apr. 11, 2018, 12:42 pm

Gov. Ralph Northam signed a new healthcare bill into law that will provide relief to many small business owners currently struggling with the Central Virginia insurance premium crisis.

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.