Wisconsin

I don't know if this is an industry trend, a state regulator trend or new policies being implemented by CMS, but it seems that either more health insurance carriers have been redacting their Actuarial Memos and/or not uploading their URRT files to the publicly-accessible SERFF database or the state insurance departments, SERFF database and/or CMS's Rate Review database aren't posting as many of them publicly.

Case in point, Wisconsin: I have the average requested 2021 premium rate filings for every carrier on the individual and small group markets...but the actuarial memos are all redacted and none of the URRTs are available at all, making it impossible for me to run a weighted average since I don't know how many enrollees each carrier has. Also, for the second year running, Compcare Health Services doesn't appear in CMS's Rate Review database at all for reasons unknown.

A few weeks ago, I posted a detailed analysis of how the COVID-19 virus has been spreading throughout Wisconsin. I noted that while the outbreak originally spread quickly in the more urban/blue-leaning areas, that has gradually changed over time, with the virus spreading to the rest of the state--including rural, conservative-leaning areas--at a faster rate while it slowed down in the urban areas.

It's time to check in to see whether that trend has continued...and sure enough, it has. Here's what this trend looks like visually:

For weeks now, I've been tracking the daily COVID-19 numbers at the county level in several states; particularly Michigan, Wisconsin and Pennsylvania. While the pandemic hit the more densely-populated areas first (which tend to lean Democratic), the trendlines in Michigan and Wisconsin have been clearly moving towards the more rural, Republican-leaning counties increasing their share of the cases and corresponding deaths as time has passed.

Pennsylvania has been different--after a less dramatic shift from blue to red counties in late March, PA seems to have levelled off, with new cases holding pretty steady between the two.

It's been another week, so I figured I should post and update...and it's more of the same in all three cases. First up, Michigan:

Yesterday I had a lengthy post in which I noted that the claims by certain Republicans/"MAGA" types that the COVID-19 pandemic was limited to "blue" areas and "big cities" (wink, wink) is quickly unraveling...at least here in Michigan.

Today, I've run the numbers and put together similar Red/Blue and Urban/Rural breakouts for another extremely closely-watched swing state: Wisconsin.

For Michigan, I was able to separate out the City of Detroit itself from the rest of Wayne County. I also included the wider "Metro Detroit Area", which consists of both Oakland and Macomb County along with the part of Wayne County outside of Detroit.

I'm a lot less familiar with Wisconsin, and they don't break out Milwaukee separately anyway, so I went with Milwaukee County, Dane County (which includes the 2nd largest city in the state, Madison), and the Rest of Wisconsin. Here's what the breakout of COVID-19 cases has looked like over time. Once again, it's really only relevant after the state reached 100 cases:

Louisiana's 2020 Presidential primary was scheduled for April 4th, but the other day Democratic Governor John Bel Edwards and Republican Secretary of State Kyle Ardoin agreed to reschedule it for June 20th...which is actually later than the last previously-scheduled primary in the U.S. Virgin Islands on June 6th:

The presidential primary elections in Louisiana slated for April will be delayed by two months, the latest in a series of dramatic steps government leaders have taken to slow the spread of the new coronavirus.

Secretary of State Kyle Ardoin, Republican, and Gov. John Bel Edwards, a Democrat, both said Friday they would use a provision of state law that allows them to move any election in an emergency situation to delay the primary.

The presidential primary elections, initially scheduled for April 4th, will now be held June 20th. Ardoin said in a press conference he does not know of any other states that have moved elections because of the new coronavirus, or COVID-19.

I posted Wisconsin's preliminary 2020 rate filings in early August. Yesterday the state insurance department posted this press release, which includes the final, approved rate changes. As far as I can tell, nothing has changed (the final statewide weighted average is a 3.2% average premium reduction over last year, thanks primarily to them implementing a fairly robust ACA Section 1332 reinsurance waiver:

​Gov. Evers Announces More Health Insurance Options for Wisconsinites in 2020 Ahead of Open Enrollment

MLR rebate payments for 2018 are being sent out to enrollees even as I type this. The data for 2018 MLR rebates won't be officially posted for another month or so, but I've managed to acquire it early, and after a lot of number-crunching the data, I've recompiled it into an easy-to-read format.

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:

I feel kind of stupid posting this in the aftermath of not one, but two massacres in El Paso, TX and Dayton, OH (at least one of which was a clear case of white nationalist terrorism inspired and encouraged by Donald Trump), but I was bout 80% done with this last night and this is part of my job, so here it is.

Wisconsin Governor Tony Evers posted the following press release:

Gov. Tony Evers today announced that 2020 rates on Wisconsin’s individual health insurance market will be 3.2 percent lower on a weighted average compared to 2019 rates. This encouraging news further demonstrates that the individual market is stabilizing and Wisconsin residents are able to access more affordable coverage options.

The rate decrease also highlights the positive impact of that the Wisconsin Healthcare Stability Plan (WIHSP), or the state’s reinsurance program, is having on the individual market. WIHSP was fully funded in the recently signed 2019-2021 state biennial budget. Without the WIHSP, rates in the individual market were expected to increase by 9 percent in 2020.

I was surprised to realize that I haven't written a word about Wisconsin since before the midterm election last fall, when Democrat Tony Evers defeated Republican incumbent Scott Walker. Since then, the state has actually gone through a lot of turmoil regarding healthcare policy (and every other policy as well, of course). The GOP still controls both the state House and Senate, so during the lame duck session they tried to pull a whole mess of crap legislation to strip Evers of his authority before he even took office...as well as that of incoming Democratic state Attorney General, Josh Kaul, to prevent him from withdrawing from the plaintiff's side in the #TexasFoldEm lawsuit, among other things.

Lawsuits were filed, and a judicial tug of war has since ensued, and the last I heard, the state Supreme Court (which leans conservative by one vote) held a hearing over the mess. I'm not sure if they've issued their final ruling yet. 

In the pile-on among Republican-controlled states to impose work requirements on ACA Medicaid expansion enrollees earlier this year, I somehow missed this one:

Wisconsin waiting to hear about requiring work, drug screening for Medicaid recipients

Wisconsin is still waiting to see if the federal government will let it require childless adults on Medicaid to be screened for drugs and work if they are able.

Gov. Scott Walker’s administration also asked in June to add premiums and co-pays for some adults without dependent children on Medicaid, which the federal government also must authorize.

The changes, which Walker said would help people move from public assistance to the workforce, can’t start until a year after approval by the Centers for Medicare and Medicaid Services, or CMS.

...Under Walker’s proposal, childless adults on Medicaid would have to submit to a drug test or enter drug treatment if drug screening called for it.

 

A few days ago, Jonathan Cohn of the Huffington Post wrote about a new phenomenon sweeping the nation: Republican candidates, all of whom have repeatedly either voted to repeal the Patient Protection & Affordable Care Act or who have repeatedly called for it to be repealed, are suddenly falling all over themselves to try and claim that they support patient protections for those with pre-existing conditions...usually by invoking family members who suffer from various ailments.

Cohn's examples include GOP Congressman Mike Bishop (MI-08), who claims his wife has rheumatoid arthritis; Dana Rohrabacher (CA-48), who says his daughter survived childhood leukemia; John Faso (NY-19) and Mario Diaz-Balart (FL-25), both of whose wives survived cancer; and Josh Hawley (MO-AG, running for MO-Sen), whose son has a rare chronic disease.

Wisconsin has an interesting situation. On the one hand, the state has what should be a robust, highly-competitive individual insurance market,with over a dozen carriers offering policies throughout the state. Granted, some of them are likely limited to only a handful of counties, but in theory they should be doing pretty well compared to rural states like Oklahoma or Wyoming, which only have a single carrier on the exchange.

On the other hand, last year Wisconsin ahd among the highest average premium rate increases in the country. Rates were projected to increase by an already-awful 36%, but when the dust settled the average unsubsidized ACA enrollee in Wisconsin was paying a whopping 44% more than they did in 2017 (it was around 45.8% higher as of the end of Open Enrollment but later dropped a bit as the year has passed and net attrition has tweaked the enrollment base).

January 2018:

It looks to me like after his short-lived 2016 Presidential campaign (seriously, it only lasted 70 days...heck, even Lincoln Chafee's campaign lasted twice as long), Wisconsin Governor Scott Walker decided to go back to shoring up his image in his home state...and since Wisconsin is one of 14 states which doesn't have any term limits for the top spot, it looks like he's scrambling to move back to the center policy-wise just in time to run for a third term this November:

Scott Walker proposes plan to prop up Obamacare marketplace

After years of fighting Obamacare, Gov. Scott Walker is now seeking to stabilize the state marketplace under the law.

Back in January, I noted that Wisconsin GOP Governor Scott Walker, who has followed the party line on the ACA since it was first signed into law, has suddenly found religion:

It looks to me like after his short-lived 2016 Presidential campaign (seriously,it only lasted 70 days...heck, even Lincoln Chafee's campaign lasted twice as long), Wisconsin Governor Scott Walker decidedto go back to shoring up his image in his home state...and since Wisconsin is one of 14 states which doesn't have any term limits for the top spot, it looks like he'sscrambling to move back to the center policy-wisejust in time to run for a third term this November:

Scott Walker proposes plan to prop up Obamacare marketplace

After years of fighting Obamacare, Gov. Scott Walker is now seeking to stabilize the state marketplace under the law.

Wisconsin plans to permission to cover expensive medical claims for health insurers on the marketplace, which should lower premium increases and could bring back companies that dropped out, the governor said in an interview with reporters on Friday ahead of his election-year State of the State address Wednesday.

The state will also ask to permanently continue SeniorCare, a prescription drug program Walker has previously sought to pare down, he said.

Walker also said he’ll ask the state Senate to pass a bill authored by Democratic lawmakers and passed by the Assembly that would enshrine into state law access to private insurance for people with pre-existing conditions.

In the most significant of his health care proposals, Walker will ask the Legislature to join a few other states in adopting a reinsurance programto prop up the individual market, which is used by some 216,000 residents, in a state innovation waiver allowed under the Affordable Care Act, or Obamacare.

It looks to me like after his short-lived 2016 Presidential campaign (seriously, it only lasted 70 days...heck, even Lincoln Chafee's campaign lasted twice as long), Wisconsin Governor Scott Walker decided to go back to shoring up his image in his home state...and since Wisconsin is one of 14 states which doesn't have any term limits for the top spot, it looks like he's scrambling to move back to the center policy-wise just in time to run for a third term this November:

Scott Walker proposes plan to prop up Obamacare marketplace

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