2018 MIDTERM ELECTION

Time: D H M S

UPDATED 6/22/18: Added Indiana and Iowa to the table.

UPDATED 6/25/18: Added Florida, Kentucky, Ohio and Texas* to the table

*(Texas only has about 1/3 of the total ACA individual market accounted for, so it could easily change)

UPDATED 7/3/18: Added Montana and Georgia to the table

UPDATED 7/13/18: Added Tennessee, updated Texas to add BCBSTX

UPDATED 7/16/18: Added Colorado

UPDATED 7/17/18: Added Nevada

Breaking out of Nevada...

The cost of plans through Nevada’s health insurance exchange are anticipated to only increase by an average of 1.9 percent next year in what the state’s insurance commissioner said is the lowest proposed rate increase from insurance companies since the Affordable Care Act went into effect in 2014.

The announcement, made by the Division of Insurance late Tuesday morning, comes amid ongoing uncertainty about the impact that Congress’s repeal of the Affordable Care Act’s individual mandate and federal rule changes for two types of non-ACA-compliant health plans will have on the individual market as a whole. Insurance Commissioner Barbara Richardson cautioned that the proposed rates are subject to change based on any action by the federal government and said the division is working “diligently” to review the proposed rates from insurance companies.

That 1.9% figure is slightly misleading, though, because...

This year, thanks to their reinsurance program, ACA individual market premiums dropped by around 23.6% on average, from a whopping $1,040/month to "only" $795/month per enrollee.

HOWEVER, they would have dropped about 4.5 percentage points more if not for Trump cutting off Cost Sharing Reduction reimbursement payments, or roughly $560/year per enrollee. AK averaged around 16,000 effectuated ACA-compliant individual market enrollees per month in 2017, so that amounts to right around $8.9 million total. 6,930 enrollees qualify for CSR assistance this year, so that averages around $1,280 apiece in CSR help, which sounds about right to me.

Last fall I wrote a lot about how different states would be dealing with the tens of millions of dollars in losses they were facing after the Trump Administration decided to cut off Cost Sharing Reduction (CSR) reimbursement payments to them. As a quick reminder, there basically four (or five, depending on your POV) options available to each carrier and/or state insurance commissioner for dealign with CSR costs for 2018:

  • No Load: They could gamble that the CSR problem would be resolved and the payments would be made after all (i.e., they would price normally).
  • Broad Load: They could spread the CSR cost out evenly across all of their 2018 ACA policies, on exchange & off.
  • Silver Load: They could load the CSR costs onto all Silver plans only (both on & off exchange).
  • Silver Switcharoo: They could load CSR costs onto all on-exchange Silver plans only, while also creating "mirror" Silver plans off-exchange without any CSR load.
  • Mixed Load: Each insurance carrier could choose whichever of the other 4 strategies they wanted to and let the chips fall where they may. Not sure if this really counts as a "strategy", since it's more or less "all of the above".

Via the Colorado Division of Insurance:

DENVER (July 13, 2018) – The Colorado Division of Insurance, part of the Department of Regulatory Agencies (DORA), today released preliminary information for proposed health plans and premiums for 2019 for individuals and small groups. Colorado consumers can file formal comments on these plans through August 3.

2018 Companies Return for 2019
The same seven companies that offered on-exchange, individual plans are returning for 2019 - Anthem (as HMO Colorado), Bright Health, Cigna Health and Life, Denver Health Medical Plans, Friday Health Plans, Kaiser Foundation Health Plan of Colorado and Rocky Mountain HMO. And like in past years, this means that all counties in Colorado will have at least one on-exchange company selling individual health plans.

 

Over at the Brookings Institute, there's a big wonky forum this morning called (De)stabilizing the ACA’s individual market: A view from the states. The panelists include several of my own healthcare heroes: Louise Norris, Brad Wright, Lynn Blewett, Cynthia Cox, Sabrina Corlette and Matt Fiedler:

The Affordable Care Act (ACA), through the individual health insurance markets, provided coverage for millions of Americans who could not get health insurance coverage through their employer or public programs. However, recent actions taken by the federal government, including Congress’s repeal of the individual mandate penalty, have led to uncertainty about market conditions for 2019. Market stabilization is currently the most critical regulatory issue that public policy officials are facing under the private insurance component of the ACA.

Holy guacamole. I've noted repeatedly that unlike last fall, when average rate increases of 20-30% or more were commonplace for ACA individual market policies (due mainly to Trump cutting off CSR reimbursement payments), the preliminary rate requests for 2019 are actually averageing quite a bit lower than originally expected; of the 20 or so states I've crunched the numbers for so far, the weighted average for unsubsidized premium hikes is hovering around the 10% mark.

At first glance, it may sound like Democrats have been overplaying their hand when it comes to the "individual mandate repeal/short-term plan expansion is causing massive hikes!" attack. However, the rate increases from deliberate sabotage are happening...they're just being partly cancelled out by other factors, including:

If you've followed this site for awhile, you may recall that about a year ago, I called out the Centers for Medicare & Medicaid (CMS) for trying to pull a fast one regarding the 2017 Open Enrollment Period data.

The short version is that they tried to make it look as though only 10.3 million of the 12.2 million people who selected Qualified Health Plans (QHPs) from the ACA exchanges actually paid their first month's premium and were actually enrolled (i.e., "effectuated"), or around 84%. They then tried using this "fact" as evidence of how the ACA was failing, etc etc, because this was supposedly down from 2016 levels.

The difference, as I noted at the time, is that the 2016 effectuation numbers were as of March, while the 2017 effectuation numbers were as of February. This made a big difference, because around 500,000 people who enrolled during 2017 Open Enrollment couldn't have been effectuated for February...because about half a million people enrolled between Jan. 16th - Jan. 31st, which meant their policies weren't even scheduled to begin until March.

When the ACA exchanges first launched for the 2014 Open Enrollment Period, the law included three individual market stabilization programs. One of the programs was called reinsurance, and as far as I know it worked pretty well. Unfortunately, the federal ACA reinsurance program sunsetted after only three years, at the end of 2016, which is part of why rates spiked so much in 2017 (they shot up in most states in 2018 as well, but for very different reasons).

In response, several states (Alaska, Minnesota and Oregon) have enacted their own, state-level reinsurance programs, and several more are on the way (New Jersey, Maryland and Wisconsin). It's a fairly cut & dried way of keeping premiums down (or even lowering them in some cases) which requires no additional federal spending and much less state spending than you would think.

Here's an example of how it works:

I never thought I'd be quoting or linking to anything published by the ultra-conservative American Action Forum, and yet here we are:

How A Trade War With China Will Impact U.S. Health Care Costs
Jacqueline Varas, Tara O'Neill Hayes

...This report examines the overall effect of these tariffs specifically on U.S. health care. On the most recent lists are an array of medical equipment, including items such as MRI machines, X-ray machines, and surgical instruments. AAF identified 55 products on the tariff lists that can be classified as medical equipment.

 

NOTE: I'll be live-updating this over the next few days, but several people have asked about it so I'm publishing the unfinished version early.

Dear Democratic candidates for Michigan State House, State Senate or Governor this November:

If you're familiar with me and this site, you probably know three things about me:

  • 1. I strongly support achieving Universal Healthcare coverage, and I'd ideally prefer to utilize some sort of Single Payer system as the payment mechanism to do so.

Last week I noted that after slashing the marketing budget for HealthCare.Gov, by a whopping 90% (from $100 million to just $10 million) and cutting the Open Enrollment Period itself in half (from 3 months to just 6 weeks) and cutting the navigator/outreach budget by 41% (from $59 million down to $36 million), Trump's CMS Dept. was "considering" slashing the navigator budget for 2019 down further yet:

The Trump administration is considering cutting funding for ObamaCare outreach groups that help people enroll in coverage, sources say.

An initial proposal by the administration would have cut the funding for the groups, known as "navigators," from $36 million last year to $10 million this year. Sources say that proposal now could be walked back, and it is possible funding could remain the same as last year, but it is unclear where the final number will end up.

 

Last month I posted a lengthy, deep-in-the-weeds analysis of Michigan Gubernatorial candidate Abdul El-Sayed's state-based Single Payer healthcare proposal, dubbed "Michicare" (later changed to simply "MichCare").

Later I noted that his primary opponent, former State Senator and County Prosecutor Gretchen Whitmer, has far thinner responses posted on her website when it comes to healthcare policy. I also noted that there are some good reasons for this which likely have nothing to do with being "a tool of the insurance lobby", a "neoliberal sellout" bla bla bla and so forth.

However, for the record, yes, Ms. Whitmer does indeed support universal healthcare coverage, as shown in the Q&A video clip above from one of her town hall appearances (thanks to Mary Bernadette Minnick Weatherly for the clip and the OK to repost it).

Below is a verbatim transcript of the whole exchange:

The big story in the 2017 Risk Adjustment report from CMS over the weekend is, of course, the fact that CMS has decided to freeze $10.4 billion in revenue transfers (or $5.2 billion, depending on your POV) in response to a judgicial ruling in a New Mexico lawsuit.

However, before the actual table breaking out all the carriers by state and how much each owes/is owed, the report includes some other interesting wonky data stuff about 2017 enrollment. Most of it wasn't of much interest to me, but one bar graph caught my eye:

I've obviously gotten a bit behind with my "ACA 2.0 spreadsheet" project...

New law preserves Affordable Care Act measures for Hawaii residents

Gov. David Ige signed a new law on Thursday that ensures certain benefits under the Affordable Care Act will be preserved under Hawaii law.

Senate Bill 2340 retains several of the measures introduced in the Obama-era legislation, also known as Obamacare, including a clause that allows Hawaii adults up to 26 years-old to continue receiving health insurance under their parents.

The law also prohibits health insurance organizations from excluding coverage to those with preexisting conditions, or using an individual's gender to determine premiums or contributions to health insurance plans.

According to Louise Norris of healthinsurance.org, here's a more clear look at what SB 2340 does:

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