CoveredCA

Back in late August, Covered California issued a formal press release stating that average 2025 rate increases for individual market policies would average 7.9% statewide.

However, that was actually only for the preliminary rate filings. In addition, at the time I only had access to California's on-exchange individual market enrollment data, so I had to guess at the off-exchange numbers.

The small group market was more frustrating: I only had enrollment data for about 1/3 of the carriers; the rest had redacted their enrollment information. This meant I couldn't even guess at a weighted average rate change.

Fortunately, my friend & colleague Louise Norris reminded me that California has, in addition to their official Insurance Department, a second insurance regulatory body, the Dept. of Managed Healthcare, which has its own database of individual, small group and large group market rate filings.

via Covered California: (this is actually from nearly a month ago; somehow I missed it at the time):

SACRAMENTO, Calif. — Covered California announced its health plans and rates for the 2025 coverage year with a preliminary weighted average rate increase of 7.9 percent.

The rate change can be attributed to many factors, including a continued rise in health care use, increases in pharmacy expenditures, the rising cost of care, labor shortages and other issues affecting the health care industry.

Because of the robust financial help available to Covered California enrollees, many will see a small impact, if any, to their monthly cost. Covered California, with the support of Gov. Newsom and the California Legislature, has worked to reduce the impact of increased consumer costs in 2025 by providing more support for its state-enhanced cost-sharing reduction (CSR) program, which will eliminate deductibles and lower the cost of care for over a million Californians.

via Covered California:

Covered California announced today that more than 158,000 Californians remained covered through the Medi-Cal to Covered California enrollment program over the past year.

Beginning in April 2023, following the end of the federal continuous coverage requirement put in place during the COVID-19 pandemic, Medi-Cal resumed its renewal process by redetermining eligibility for over 15 million of its members. In May 2023, Covered California and the Department of Health Care Services (DHCS), which administers California’s Medi-Cal program, launched the Medi-Cal to Covered California enrollment program.

Under the program, Covered California automatically enrolls individuals in one of its low-cost health plans when they lose Medi-Cal coverage and gain eligibility for financial help through Covered California. Through early June of 2024, the program has helped 158,100 Californians remain insured.

As I noted a month ago, as of January 1st, 2024, California extended Medicaid (Medi-Cal) eligibility to around 700,000 more undocumented residents:

On Jan. 1, immigrants may qualify for Medi-Cal regardless of legal status

...Milagro and her husband are among the more than 700,000 immigrants ages 26-49 expected to newly qualify for full health insurance come Jan. 1. That’s when California takes the final step in opening up Medi-Cal, the state’s health care program for low-income residents, to everyone who meets eligibility requirements, regardless of their immigration status.

Because of this, I admit to scratching my head at first when I read this article from the Redwood City Pulse:

Good grief. I have no idea how I missed this legislation. I had read about and even written about it several times over the past several years, but I sort of lost track of it since the COVID pandemic hit.

Back in 2016, California passed a bill which extened eligibility for Medi-Cal (California's brand name for Medicaid) to around 170,000 undocumented children statewide...although this ultimately ended up resulting in around 250,000 children being added to the roles.

Then, in 2019, California's expansion of Medicaid to undocumented residents moved to the next phase: Around 100,000 more young undocumented adults aged 19 - 25 years old.

Originally posted 7/26/23; updated 11/02/23

via Covered California:

Covered California’s Health Plans and Rates for 2024: More Affordability Support and Consumer Choices Will Shield Many From Rate Increase

SACRAMENTO, Calif. — Covered California announced its health plans and rates for the 2024 coverage year with a preliminary weighted average rate increase of 9.6 percent.

The rate change can be attributed to many factors, including a continued rise in health care utilization following the pandemic, increases in pharmacy costs, and inflationary pressures in the health care industry, such as the rising cost of care, labor shortages and salary and wage increases.

In July, Covered California announced the preliminary weighted average 2024 premium rate changes for the ACA individual market. They still haven't released the final/approved rates, or the small group market average rate changes, but today they released the final rate changes for standalone dental plans:

SACRAMENTO, Calif. — Covered California announced that the statewide weighted average rate change for dental coverage in 2024 will be 4.31 percent. The rate increase is the first since 2020 and continues a trend of holding costs steady for consumers.

Last month I posted an explainer about a situation in California which boiled down to a huge pot of extra revenue (~$330 million per year, give or take) being fought over between Governor Gavin Newsom and the Democratically-controlled State Legislature.

The bottom line is that this funding was intended to go towards reducing health insurance premiums for ACA exchange enrollees via Covered California as supplemental subsidies to be added on top of federal ACA tax credits...but the passage of the American Rescue Plan and the subsequent Inflation Reduction Act kind of made that moot, since the federal subsidies were made more generous than what the state subsidies would have been anyway.

As a result, Gov. Newsom decided that the extra revenue should go into the general state fund, while Democrats on the state legislature wanted to redirect it to eliminate deductibles and other types of cost sharing for ACA enrollees instead. This led to an impasse for the past several months:

This post has a long intro, but please bear with me...

Back in 2018, after the then-Republican controlled Congress zeroed out the ACA's federal "individual mandate penalty" (officially the "shared responsibility penalty"), I posted both a video and slideshow explainer about what this penalty was and why it was included in the ACA in the first place.

The very short and simplified version is this:

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