END OF 2018 OPEN ENROLLMENT PERIOD (42 states)

Time: D H M S

2018 Open Enrollment Quick Links


Back in August, I reported that thanks to their just-approved federal reinsurance program, Alaska (which has only a single individual market carrier with the most expensive premiums in the country) is looking at an impressive 22% average decrease in their indy market premiums next year. However, that was based on the assumption that CSR reimbursement payments would not be made (or at least not guaranteed).

Last week the Alaska Journal of Commerce reported that the final, approved 2018 rates have been released, and Premera Blue Cross Blue Shield will instead be lowering rates even further:

Alaskans buying health insurance on the individual market will see a decrease of 26.5 percent in rates next year, the sole insurer in the state announced Tuesday.

Alaskans had been paying some of the highest premiums in the nation.

(h/t to Twitter follower @dcodea for the "Brewster's Millions" idea)

According to Tom Price's own Health & Human Services Department, the average unsubsidized premium paid by ACA exchange enrollees this year is around $476 per month, or $5,712 for the full year.

According to the latest investigative report by Politico healthcare reporters Rachana Pradhan and Dan Diamond, HHS Secretary Tom Price has racked up over a million dollars in taxpayer-funded air travel...since May.

The White House approved the use of military aircraft for multi-national trips by Health and Human Services Secretary Tom Price to Africa and Europe this spring, and to Asia in the summer, at a cost of more than $500,000 to taxpayers.

The overseas trips bring the total cost to taxpayers of Price’s travels to more than $1 million since May, according to a POLITICO review.

Maybe Tom Price is trying to take the heat off of his chartered jet shenanigans, but whatever the reason, this is welcome news:

CMS Announces Special Enrollment Periods for Americans Impacted by Recent Hurricanes
Agency provides special open enrollment periods for 2017 Medicare and Exchange coverage

As a result of Hurricanes Harvey, Irma, and Maria, the Centers for Medicare & Medicaid Services (CMS) will make available special enrollment periods for all Medicare beneficiaries and certain individuals seeking health plans offered through the Federal Health Insurance Exchange. This important step gives these individuals and families who have been impacted by the hurricanes the opportunity to change their Medicare health and prescription drug plans and gain access to health coverage on the Exchange immediately if eligible for a special enrollment period.

Some Guy, September 19th:

More to the point, however: What other significance does not including CSR funding have?

Well, first of all, is it possible that they'll slip CSRs in before the vote? I suppose so, but consider this:

  • The final deadline for the insurance carriers to actually sign their contracts for 2018 is Sept. 27th, just 8 days from now.
  • The end of the 2017 fiscal year (i.e., the deadline for the GOP to try and cram through Graham-Cassidy with only 50 Senate votes) is Sept. 30th.
  • The CBO is "aiming" to provide a "preliminary assessment" of Graham-Cassidy "early next week" which I presume means Monday the 25th or Tuesday the 26th.
  • I assume the other steps (parlimentary ruling, vote-a-rama, etc) would take place on Wednesday the 27th, the same day the contracts have to be signed.
  • Yom Kippur is the evening of the 29th, running through Saturday the 30th. I can't imagine even McConnell would be that much of a dick to schedule the vote then.
  • That leaves Thursday the 28th or Friday the 29th for the actual vote itself.

That's a day or two after the carrier contracts have been signed.

Then, just this week, after Senators Collins, McCain, Paul—and potentially Murkowski—announced their opposition to the bill, the GOP leadership announced that the Senate would not vote on Graham-Cassidy. Given budget reconciliation rules, the Senate only has until September 30th to pass a repeal bill with just 50 votes (Vice President Pence then casting the tie-breaking vote). Thus, it would appear that repeal efforts will be delayed until the spring of 2018 when fiscal year 2019 begins, and new budget reconciliation rules are established. All of that said, I am sick and tired of sitting on pins and needles as this process has unfolded. Based on the submissions I received this week, many of my colleagues seem to share my sentiments, as very few posts focused on Graham-Cassidy. In recognition of that, I present you with the “Repeal Fatigue” edition of the Health Wonk Review.

Earlier today, the Georgia Department of Insurance issued this press release:

INSURANCE DEPARTMENT RELEASES PROPOSED RATES FOR 2018 HEALTHCARE EXCHANGE

Atlanta – Insurance Commissioner Ralph Hudgens announced today that his office had submitted proposed 2018 health insurance rates to the Centers for Medicare and Medicaid Services (CMS) for the federally-facilitated Healthcare Exchange for final federal approval.

“Today my office submitted 2018 Obamacare rates to Washington D.C. for approval,” Hudgens said. “In its fifth year, Obamacare has become even more unaffordable for Georgia’s middle class with potential premium increases up to 57.5 percent. I am disappointed by reports that the latest Obamacare repeal has stalled once again and urge Congress to take action to end this failed health insurance experiment.”

 

At this point, the Trump Administration's ongoing efforts to sabotage the Affordable Care Act in general and this fall's Open Enrollment Period in particular are so offensive and ham-handed they should be dating Miss Piggy.

Trump administration abruptly drops out of Obamacare events in Mississippi
“It’s clearly sabotage.”

For the past three years, the US Health and Human Services Department has partnered with a health advocacy group in Mississippi on an education tour before Obamacare enrollment started. They would meet around the states with groups that sign people up for coverage — state officials, health centers, insurance brokers, and the like — to prepare for open enrollment.

Up until Monday, Roy Mitchell, executive director of the Mississippi Health Advocacy Program, thought these events were going forward in the coming weeks as planned. He had even asked HHS just last week for biographies of the officials they’d be sending.

Me, 8 days ago:

More to the point, however: What other significance does not including CSR funding have?

...That means that even if there's a last minute change to the bill, at this point, CSR payments are virtually certain not be guaranteed next year.

...I wouldn't be at all surprised to see more 11th-hour drop-outs next week. Donald Trump and the Republican Party's open sabotage of the ACA will likely bear even more fruit.

Today, literally 11 hours before the contract signing deadline:

Anthem leaving Maine ACA marketplace, citing uncertainty

Anthem Blue Cross Blue Shield has withdrawn nearly all of its offerings from Maine’s Affordable Care Act health insurance marketplace, and the insurer is citing market uncertainty and volatility as the reasons.

Presented with minimal comment:

Individual Segment Findings

There's no denying the Individual health insurance market has endured its fair share of challenges. In order for this segment to be sustainable there must be adequate membership and a balanced risk pool, slow growth in healthcare spending while maintaining quality of care and enough health insurer participation and plan offerings to bolster consumer choice. The volatility of the Affordable Care Act's (ACAs) exchange program forced many insurers to significantly raise premiums to make up for financial losses due to imbalanced risk pools, or withdraw from the exchanges altogether. In 2016, insurance premiums exceeded medical care costs for many insurers; however, segment profitability was still elusive to most plans. MFA's assessment of mid-year 2017 profitability for the Individual market indicates improved overall results.

HE'S OUT. SEE UPDATE AT BOTTOM.

So this morning I read this story at Politico by Dan Diamond and Rachana Pardhan:

Price’s private-jet travels included visits with colleagues, lunch with son

Health and Human Services Secretary Tom Price took a government-funded private jet in August to get to St. Simons Island, an exclusive Georgia resort where he and his wife own land, a day and a half before he addressed a group of local doctors at a medical conference that he and his wife have long attended.

The St. Simons Island trip was one of two taxpayer-funded flights on private jets in which Price traveled to places where he owns property, and paired official visits with meetings with longtime colleagues and family members. On June 6, HHS chartered a jet to fly Price to Nashville, Tennessee, where he owns a condominium and where his son resides. Price toured a medicine dispensary and spoke to a local health summit organized by a longtime friend. He also had lunch with his son, an HHS official confirmed.

...and the immediate fallout as summarized below...

I've spent the past two weeks posting about almost nothing besides the Graham-Cassidy debacle, so haven't had a chance to keep on top of the approved 2018 rate changes as I usually do. Fortunately, Louise Norris of healthinsurance.org has stayed on the rate hike job, and reports the final numbers out of Washington State:

2018 rates: 24% approved rate increase, due in large part to federal uncertainty — and higher backup rates will be implemented if CSR funding is cut mid-year

Insurers in Washington had to file rates and plans for 2018 by June 7, 2017. On June 8, Kreidler’s office published a summary of what had been filed (rate filings are available here, and that page will show final rate changes for the individual market once they’re approved), and publicized the filing details on June 19. The average proposed rate increase in Washington, before any subsidies are applied, was 22.3 percent.

Back in August it looked as though Florida carriers were looking at either 15.5% unsubsidized rate increases on the individual market if CSR reimbursement payments were guaranteed next year, or around 35.5% if they weren't. Well, the official rates have been released by the Florida Dept. of Insurance, and it's even uglier than that for unsubsidized enrollees:

Office Announces Submission of Proposed Rates for 2018 Federal PPACA Health Insurance Plans

 

As you've probably heard fby now, Mitch McConnell has formally/officially pulled the latest incarnation of Trumpcare, aka "Graham-Cassidy" (or "Graham-Cassidy-Heller-Johnson" for those who love hyphens) from being voted on this week before the September 30th reconciliation deadline:

Republican leaders have decided not to vote on Obamacare repeal legislation this week, effectively ending the party’s latest effort to wipe away the 2010 health care law.

When, and whether, they will try again remains to be seen. But for now, a defining cause of the Republican Party, including President Donald Trump, lies in tatters.

And at least for the moment, insurance coverage for many millions of Americans who rely on Medicaid or the Affordable Care Act’s federal subsidies remains intact ― although insurance markets in some states remain unstable, and the Trump administration’s willingness to manage the program remains unclear.

(sigh) When I last checked in on Virginia, things were looking up a bit (relatively speaking), as Anthem Blue Cross Blue Shield (aka "HealthKeepers") had announced that they were jumping back into the state in order to cover the 60-odd counties which would otherwise be left bare by Optima Health Insurance dropping out of half the state a week or so earlier.

Unfortunately, while this did resolve the "bare county" problem for VA, it didn't resolve the other big problem: Major rate hikes for unsubsidized individual market enrollees:

As many see their options for health plans dwindle down to one insurer, premiums are simultaneously set to rise by an average of 57.7 percent next year in Virginia’s individual marketplace.

The increase is “unquestionably the highest we’ve ever seen,” David Shea, health actuary with Virginia’s Bureau of Insurance, told lawmakers Monday.

Yesterday was a Graham-Cassidy (or "Grassidy", as former CMS Administrator Andy Slavitt keeps trying to push) Fest, with all sorts of Grassidy-centric happenings, including the one-and-only Senate hearing on the bill; the Congressional Budget Office releasing their preliminary/partial score of G-C (the prior version, not the later version); Senator Susan Collins releasing her statement opposing the bill; and last night's CNN healthcare debate between Senators Graham & Cassidy vs. Senators Sanders and Klobucher. I might write something about these items later today, but right now I want to look at another development.

Pages