UPDATE 8/20/19: I originally posted this in late June. Since then, there have been several important developments: Joe Biden and Kamala Harris have formally rolled out their own official healthcare overhaul plans, with Harris splitting off from Bernie Sanders' fully-mandatory "Medicare for All" bill to her own variant, which keeps the name but has similarities to "Medicare for America". Also, Eric Swalwell and John Hickenlooper have dropped out (ok, not every development was major).
I've updated the post to reflect these changes, while also updating the table graphic, which I've also simplified by removing Swalwell, Hickenlooper and most of the other bottom-rung candidates. I'm keeping everyone who's qualified for the September/October debates as of this writing, plus Tulsi Gabbard, Jay Inslee and Tom Steyer, each of whom is partly qualified.
How Pending Decision on Obamacare Could Upend 2020 Campaign
A federal appeals court’s ruling on the Affordable Care Act could be a huge headache for the president and take Democrats’ focus off Medicare for all.
A federal appeals court in New Orleans is preparing a ruling on the Affordable Care Act that could put the law’s future front and center in the presidential race, overwhelming the current Democratic debate over Medicare for all and reigniting the health care-driven worries that helped Democrats win back the House last year.
I noted yesterday that Virginia is the latest state to consider jumping onboard the State-Based Exchange train, joining Nevada, New Mexico, New Jersey, Pennsylvania, Maine and possibly Oregon in making the move. Every time I've mentioned Oregon, however, I've had to put a bit of an asterisk on it because I wasn't quite sure whether or not their shift back to their own full tech platform was still a go or not.
Like Nevada, Oregon did have their own full exchange once upon a time. Back in the first ACA Open Enrollment Period from 2013-2014, both states were among those which ran their own exchange websites. Nevada's was developed by Xerox; Oregon's was developed by Oracle.
Back in early August, I ran the preliminary average unsubsidized 2020 individual market rate changes in Arizona. At the time, I had the requested rate changes for both the individual and small group markets, but not the actual enrollment numbers for each carrier, so I had no way of calculating the weighted average. I instead settled for a simple unweighted average, which came in at around a 2.4% reduction in premiums on the individual market and a 5.2% increase on the small group market.
A few days ago, the Arizona Insurance Dept. released the final/approved 2020 rate changes, and there was only one significant change: Health Net of AZ (dba Arizona Complete Health), which had requested a 2.9% rate reduction, will instead be keeping their premiums flat year over year on average. With Health Net holding over 50% of the market share, this meant that the statewide average is a bit higher than I had it previously.
Believe me, I was certain that I had finally gotten this year's Medical Loss Ratio (MLR) rebate project out of my system. I really was.
However, there was one other MLR-related issue which I've wondered about for years: The ACA requires that carriers who sell policies in the Individual and Small Group markets spend at least 80% of the premium revenue on actual medical claims (limiting them to a 20% gross margin), and 85% on the Large Group market (limiting them to 15% gross).
That accounts for around 165 million people, give or take...roughly 50% of the total U.S. population...but what about the other private (or at least semi-private) insurance markets? I'm referring, of course, to privately-administered Medicare and Medicaid plans...aka Medicare Advantage and Managed Care Organizations (MCOs).
Governor Northam Signs Executive Directive to Ensure Access to Affordable, Quality Health Care Coverage for All Virginians
RICHMOND—Governor Ralph Northam today issued Executive Directive Five, directing actions to increase the number of Virginians enrolled in quality, affordable health care coverage.
This year, Medicaid expansion is providing access to health coverage for more than 325,000 eligible Virginians who have enrolled, positively impacting their health. But meaningful health coverage remains unaffordable for too many Virginians, due in large part to federal policies that have increased cost and decreased the quality of available coverage.
Back in July, the Pennsylvania Insurance Dept. posted the preliminary/requested 2020 average premium rate changes for the individual and small group markets. The ACA-compliant individual market average increase was around 4.6%; for small businesses, the average was 9.6%.
Today they finally posted the approved rate changes for each...and the indy market average has dropped to a 3.8% increase, while the small group market has gone up just a hair to 9.7%.
HOWEVER, for the time being at least, that seems to be where she's decided to lay her marker, so it is what it is.
The single biggest headache she's been dealing with all summer and fall, however, has been the "Will You Raise Taxes On The Middle Class" question which keeps popping up in interviews and the Democratic debates. Bernie Sanders has, to his credit or detriment, stated it plainly: Yes, his plan would indeed raise taxes on households earning more than $29,000/year.
I'm not sure when the other 7 state-based exchanges will launch their 2020 window shopping tools, nor do I know when HealthCare.Gov's window shopping will be open for the other 38 states, although I believe they usually do so about a week ahead of the official November 1st Open Enrollment Period launch date.
I also noted that there's two important points for CA residents to keep in mind starting this Open Enrollment Period:
First: The individual mandate penalty has been reinstated for CA residents. If you don't have qualifying coverage or receive an exemption, you'll have to pay a financial penalty when you file your taxes in 2021, and...
Second: California has expanded and enhanced financial subsidies for ACA exchange enrollees:
Until now, only CoveredCA enrollees earning 138-400% of the Federal Poverty Line were eligible for ACA financial assistance. Starting in 2020, however, enrollees earning 400-600% FPL may be eligible as well (around $50K - $75K/year if you're single, or $100K - $150K for a family of four). In addition, those earning 200-400% FPL will see their ACA subsidies enhanced a bit.
While the 2020 Open Enrollment Period doesn't officially start until November 1st across the rest of the country, in California it begins two weeks earlier, for whatever reason:
In most states, open enrollment for 2020 coverage will run from November 1, 2019 to December 15, 2019. But California enacted legislation (A.B.156) in late 2017 that codifies a three-month open enrollment period going forward — California will not be switching to the November 1 – December 15 open enrollment window that other states are using.
Instead, California’s open enrollment period (both on- and off-exchange) will begin each year on October 15, and will continue until January 15. Under the terms of the legislation, coverage purchased between October 15 and December 15 will be effective January 1 of the coming year, while coverage purchased between December 16 and January 15 will be effective February 1.
Back in July, the Colorado Insurance Dept. announced the preliminary 2020 avg. premium rate changes for the individual and small group markets, including making the important point that their then-pending Section 1332 Reinsurance Waiver program, if approved, would cut down on unsubsidized premiums by over 18% on average (18.2%, to be precise, according to the CO DOI, although my own analysis based on the preliminary rate filings brought it in at a 17.5% reduction).
As you may recall, I managed to acquire all 2,700 MLR template filing spreadsheets from the CMS website a solid month before the data was made available to the public. After spending countless hours digging through them and compiling the data on a state-by-state basis, I concluded that the final breakout was as follows:
Individual Market: $769 million in rebates being paid back to 3.34 million ACA enrollees
Small Group Market: $312 million in rebates being paid back to 2.96 million enrollees
Large Group Market: $290 million in rebates being paid back to 2.31 million enrollees
TOTAL: $1.37 billion in rebates being paid back to 8.61 million enrollees nationally
With the 2020 Open Enrollment Period rapidly approaching (it actually kicks off on October 15th in California, and on November 1st in every other state + DC), it's important to keep in mind that many people who didn't qualify for financial assistance in 2019 may qualify in 2020...and in some cases that could mean a difference of thousands of dollars due to how the ACA subsidy formula works and other factors.
First, a refresher on how the ACA formula works for Individual Market enrollees (that is, people who are looking to buy health insurance for themselves and/or their family who don't receive it through their employer, Medicare, Medicaid, CHIP or some other source).