Washington State

I honestly can't make heads or tails out of what, exactly, the just-passed HB2516 from the Washington State legislature actually does, but the WA Health Benefit Exchange seems to be pretty happy about whatever it is:

Today, Pam MacEwan, CEO of the Washington Health Benefit Exchange, issued the following statement on the signing of House Bill 2516: 

“The Washington Health Benefit Exchange applauds today’s signing of House Bill 2516 by Gov. Jay Inslee.

“This state-level legislation protects important progress made in Washington state under the Affordable Care Act. Our position as the state’s health insurance gateway is now stronger than ever, and despite continued uncertainty we may see at the federal level, this bill enables us to continue improving the customer experience for the people in our state.

I should note up front that despite the snarky headline, this is actually good news on the whole, and Premera does deserve some credit for it since part of the $250 million they refer to below is voluntary on their part.

Premera Blue Cross, the sole carrier offering ACA exchange individual market policies throughout the entire state of Alaska, and one of the major carriers on the indy market in Washington State, posted this press release today:

Premera Announces $250 Million Investment In Customers and Community

Mountlake Terrace, Wash. — (March 12, 2018) — Premera Blue Cross, a leading health plan in the Pacific Northwest, today announced $250 million in investments over five years across Washington and Alaska to help stabilize the individual market, improve access to care in rural areas and support local communities in their efforts to address the behavioral health issues impacting their residents.

Washington State Insurance Commissioner Mike Kreidler has decided to shut down Donald Trump's #ShortAssPlans executive order before it starts infecting the Evergreen State (yes, that's their official nickname...I looked it up):

Kreidler announces intention to being rulemaking on short-term medical plans

March 6, 2018

OLYMPIA, Wash. – Insurance Commissioner Mike Kreidler announced his intention today to begin rule-making to create protections for Washington consumers who buy short-term medical plans. He is taking this action in response to the recent rules the Trump administration proposed to increase the duration of short-term medical plans from 90 days to up to 364 days.

In a statement last week, Kreidler shared his concerns about short-term medical plans:

Now that the 2018 Open Enrollment period is officially over in every state +DC, I've started compiling more detailed demographic breakouts of the data on a state-by-state basis. The official CMS report from the Assistant Secretary for Planning & Evaluation (ASPE) report should be released at some point in the next couple of weeks, but until then, I'll have to settle for whatever reports I can patch together from some of the state-based exchanges.

So far I've dug up final (or near final) data for six states: Colorado, Connecticut, Idaho, Maryland, Minnesota and Washington State. Collectively, these states only represent about 890,000 2018 exchange enrollees, or roughly 7.5% of the 11.8 million total, so I have no idea how representative they are nationally, but it's all I have to work with for the moment.

The type of demographic data available varies greatly from state to state, but a major data point available from all six of them also happens to be one of the more interesting points, especially this year, given the " CSR Silver Loading" gambit available in most states this year.

Look what I dug up on the Washington Health Benefit Exchange website!

That's right...it's time for another state-level Datapalooza!® The first two slides come from the Feb. 2nd board meeting Open Enrollment Report; the rest come from the "Open Enrollment For 2018 Plan Year Performance Dashboard" report, which is a bit different; it actually runs through January 26th instead of January 14th for whatever reason. so some of the numbers are slightly different.

Last Thursday Hannah Recht alerted me to an internal slideshow presentation at the Washington Health Benefit Exchange which included rough final Open Enrollment numbers for Washington State, totally around 242,800 people.

Today the WA exchange has issued a formal press release with the official numbers, which are...exactly 50 enrollees higher than that:

Washington Healthplanfinder Closes Open Enrollment with Record 242,000 Sign-Ups
Health plan selections spike eight percent over last year, dental plan selections jump 12 percent

OLYMPIA, Wash. – The Washington Health Benefit Exchange announced today that more than 242,000 customers signed up for Qualified Health Plans (QHP) through Washington Healthplanfinder by the close of open enrollment on Jan. 15 – an eight percent increase over the previous year.

A few days ago I reported that the Washington Health Benefit Exchange had enrolled 234,000 people in private policies for 2018 when they had just a couple of days left to go.

Today Hannah Recht provided a link to this WA state navigator meeting in which rough final numbers were included as part of the slideshow presentation, along with a bunch of other data points which should be of interest to other healthcare/navigator wonks. 242,800 is a rough number but assuming it doesn't get changed by much, it means the Apple State enrolled 7.6% more people in QHPs this year than last, with nearly 1/3 of them being new to the WA exchange.

Washington State was already beating their 2017 numbers anyway, so this update just pads their lead.

Ten days ago the Washington Health Benefit Exchange reported having enrolled around 231,500 people in 2018 policies after having purged a few thousand who were auto-renewed but then cancelled. This still left them over 6,000 enrollees ahead of last year's final total of 225,600.

Today, with one day left for people to sign up before the January 15th deadline, the Seattle Times reports that WA's tally is up to 234,000:

Washington state is on pace to increase the number of people with health insurance despite efforts by the Republican Congress and the Trump administration to gut the laws known as Obamacare that expanded insurance coverage across the nation.

Whenever I write or talk about the 3-Legged Stool of the ACA and the actual flaws in the law (as opposed to the ones deliberately created by the GOP), I usually focus on two "gaps" in the legs: The APTC subsidies getting cut off at 400% FPL and being too stingy below that level, and the individual mandate not being large enough (and not being properly enforced). As it happens, part of the first problem has already been unintentionally "solved" thanks to Trump's ham-handed CSR reimbursement cut-off (which ended up increasing APTC tax credits for those below the 400% cut-off), while the second problem has just been made a whole lot worse thanks ot the GOP repealing the mandate altogether.

However, in focusing on the legs of the stool, I often forget to mention another important issue: The width of the seat itself. That is, how wide the network of doctors and hospitals which accept the policy is. The Affordable Care Act does give some guidelines/regulations about how wide ACA-compliant policy networks have to be, like so:

Presented without comment because I don't really have much to add aside from yes, this is a good idea which should happen for EVERY state, really:

Kreidler proposes bill to stabilize individual market, reduce premium costs
Contact Public Affairs: 360-725-7055

January 8, 2018

OLYMPIA, Wash. – Insurance Commissioner Mike Kreidler is proposing legislation to help provide stability and confidence that over 300,000 people are able to maintain coverage in Washington’s individual health insurance market.

Kreidler’s proposed reinsurance program would encourage more health plan options in the 2019 individual market and lower premium increases by up to 10 percent.