Charles Gaba's blog

OK, bear with me.

First, I want you to click this link and read this long, wonky post from back in February about the ongoing CSR class action lawsuit saga and the potential consequences. I'll wait right here.

OK, done reading it?

For those of you too impatient to read the backstory, here's the VERY short version:

 

Just 9 days ahead of the official launch of the 2020 ACA Open Enrollment Period (California already started theirs), the House Energy & Commerce Health Subcommittee will be holding a livestreamed hearing with CMS Administrator Seema Verma:

HEARING ON "SABOTAGE: THE TRUMP ADMINISTRATION'S ATTACK ON HEALTH CARE"

  • Date: Wednesday, October 23, 2019 - 10:00am
  • Location: 2123 Rayburn House Office Building
  • Subcommittees: 116th Congress, Energy and Commerce (116th Congress), Oversight and Investigations (116th Congress)

The Subcommittee on Oversight and Investigations of the Committee on Energy and Commerce will hold a hearing on Wednesday, October 23, 2019, at 10 a.m. in the John D. Dingell Room, 2123 of the Rayburn House Office Building.

I've been expecting this exact press release from Trump's HHS Dept. to drop for awhile now:

Premiums for HealthCare.gov Plans are down 4 percent but remain unaffordable to non-subsidized consumers

Today, the Centers for Medicare & Medicaid Services (CMS) announced that the average premium for the second lowest cost silver plan on HealthCare.gov for a 27 year-old will drop by 4 percent for the 2020 coverage year. Additionally, 20 more issuers will participate in states that use the Federal Health Insurance Exchange platform in 2020 bringing the total to 175 issuers compared to 132 in 2018, delivering more choice and competition for consumers. As a result of the Trump Administration’s actions to stabilize the market, Americans will experience lower premiums along with greater choice for the second consecutive year.

It is with profound grief that I announce that our beloved german shepherd Bella, the best, most wonderful, most gentle good girl in the world, died suddenly this morning at around 11am. She was only 9 years old.

The vet told us she had a pericardial effusion caused by a hemangiosarcoma...an aggressive, cancerous tumor near the heart with no advance signs which likely ruptured in the middle of the night, causing bleeding & fluid to build up in turn leading to vomiting and death.

Apparently there was no way for a veterinarian to detect it until it actually burst unless they knew it was there already. She seemed perfectly fine last evening. At around 2:30am she vomited & defecated profusely.

She seemed better after that...was drinking water and responding pretty well. We decided to see how she was in the morning & take her to the vet if necessary. This morning she was sleeping deeply but seemed to be breathing OK.

A little bit later, though, she took a turn for a worse. We rushed her to the emergency animal clinic up the road. I think she died as we were pulling up. The only 'positive' is that the vet said bringing her in a few hours earlier wouldn't have made any difference.

I haven't written about it in a few weeks, but the ruling from the 5th Circuit Court of Appeals could (and likely will) be released any day now, so it's a good thing that Abby Goodnough wrote this piece for the New York Times today:

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).

It took me a couple of days to post this, but it's an important development, especially on the cusp of the Virginia legislative election next month which could flip both the state House and Senate to the Democrats; thanks to Esther Ferington for the heads up:

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%.

(sigh) Regular readers know two things about me when it comes to Sen. Elizabeth Warren:

  • I'm generally supporting Elizabeth Warren in the Democratic Primary (not a full endorsement, but I've been strongly leaning her way for awhile now)...

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 how this slipped by me, but in addition to Covered California already having launched their 2020 Open Enrollment Period yesterday, five other state-based ACA exchanges are already partly open as well. That is, you can shop around, compare prices on next year's health insurance policies and check and see what sort of financial assistance you may be eligible for:

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.

 As I noted yesterday, while the 2020 Open Enrollment Period doesn't officially start until November 1st across the rest of the country, in California it already started on October 15th, two weeks earlier than everywhere else.

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.

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

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