A week ago, Vox's Sarah Kliff reported that the Trump Administration was slashing the 2018 Open Enrollment Period advertising budget by 90% and the navigator/outreach grant budget by nearly 40%. As I noted at the time, the potential negative impact of these moves on enrollment numbers this fall--coming on top of the period being slashed in half, the CSR reimbursement and mandate enforcement sabotage efforts of the Trump/Price HHS Dept. and the general confusion and uncertainty being felt by the GOP spending the past 7 months desperately attempting to repeal the ACA altogether could be significant. In states utilizing the federal exchange (HealthCare.Gov), 2017 enrollment was running neck & neck with 2016 right up until the critical final week...which played out under the Trump Administration, which killed off the final ad/marketing blitz.
Result? A 5.3% total enrollment drop (or 4.7% if you don't include Louisiana, which expanded Medicaid halfway through the year) via HC.gov, while the 12 state-based exchanges--which run their own marketing/advertising budgets--saw a 1.8% increase in total enrollment year over year.
The database at the link above doesn't include the enrollee market share numbers; for that I had to dig up the actual filings at the SERFF database. Blue Cross Blue Shield and Presbyterian seem to be assuming no significant TrumpTax next year (which makes sense, since both will be off-exchange only, thus not subject to CSR payment concerns). Molina's filing is kind of odd--they seem to assume that CSR payments will be made...but that the individual mandate won't be enforced, which seems rather backwards to me (most TrumpTax filings assume neither will be enforced, or that the mandate will but CSR payments won't).
New Mexico is one of five states (also including Nevada, Oregon, Hawaii and Kentucky) which technically operate their own state-based ACA exchange, but utilize HealthCare.Gov as their website enrollment platform. As such, their enrollment numbers are usually only released along with the other three dozen states on the federal exchange.
However, once in awhile they post the enrollment numbers themselves; today is such a day:
@charles_gabaNMHIX: 52,006 total signups - almost as much as last year. Still anticipating a surge as NMHIX continues ads and outreach.
The breakout here is 36,579 renewals + 15,427 new enrollees, or a 70/30 split.
Last year, New Mexico's total came in at 54,865 QHP selections, so they've hit 95% of that so far.
My original target for New Mexico for this year was 60,000, though I've knocked this down to 57,000 more recently. They're at around 91% of that so far, with less than a week to go. They'll have to add another 5,000 people in the final surge, which seems unlikely, but who knows?
In New Mexico, assuming 57,000 people enroll in private exchange policies by the end of January, I estimate around 25,000 of them would be forced off of their private policy upon an immediate-effect full ACA repeal, plus another 260,000 enrolled in the ACA Medicaid expansion program, for a total of 285,000 residents kicked to the curb.
As for the individual market, my standard methodology applies:
Three of the 5 carriers had their final requests approved exactly as is by state regulators. CHRISTUS and Molina have yet to be approved, but based on a lengthy online conversation with someone very much in the know about the New Mexico health insurance market, I'm highly inclined to believe that both of their final asks will be approved as is as well.
The good news is that it's easy to use, and lists all of the carrier rate hike requests in a clearcut manner...except, oddly, for CHRISTUS, which I'm pretty sure is being offered this year.
The bad news is that it doesn't include any of the actual market share/enrollment numbers, making it impossible to come up with a weighted average. Some of these are available via redacted filings over at the federal RateReview.Healthcare.Gov site, but not all of them. I have New Mexico Health Connections estimated at 48,000 based on this report, but I have no idea how many CHRISTUS or Presbyterian enrollees there are.
The RateReview site lists CHRISTUS as ranging from 9.4 - 15.2%, but without market share numbers I can't even come up with a proper rate hike request, so I've split the difference for now at 12.3%.
A couple of days ago I noted that after two years of nothing but doom & gloom (and coming just a week after UnitedHealthcare pulled the plug on the individual market in over two dozen states) there seems to finally be some positive developments, with companies like Centene and Anthem reporting better-than-expected results. They may not be making a profit yet, but at least they aren't losing money hand over fist the way they did the first couple of years.
I also made a brief mention of the Maryland Co-Op, Evergreen Health, which reported their first quarterly profit since launching 2 1/2 years ago.
Consumer operated and oriented health plans in Maryland, New Mexico and Massachusetts will report profits in the first quarter, in a sign that some of the remaining Affordable Care Act-created nonprofits could be finding their footing on the state exchanges.
As anyone who's been following the ACA exchange saga over the past few years knows, the original idea was that all 50 states (+DC) would establish their own, individual healthcare exchange, including their own website/technology platform for enrolling residents in private policies (QHPs), Medicaid (supplementing or replacing whatever existing Medicaid system they already had) and small business policies (the ACA's SHOP program). In addition, each state exchange would also have their own board of directors, marketing department, support call center, fee structure for covering the cost of operations and so on.
If things had worked out that way, there would have been 51 different websites where people would enroll in ACA policies, each one independently branded.
The dozen collapses will disrupt insurance for 740,000 individuals and small-business employees, who are being instructed by state and federal officials to choose new plans in time for them to take effect in January. In New York state, the window is narrower. Government officials have moved up the closing date of the New York Health Republic co-op, the nation’s largest, giving its more than 200,000 members just two weeks to select different coverage before it shuts down at the end of this month.
Although it lost money in 2014, New Mexico Health Connections is “financially very strong” with strong cash reserves, CEO Martin Hickey said Wednesday. In fact, the co-op expects to greatly expand by picking up consumers who had been insured with Blue Cross Blue Shield New Mexico on the state health exchange. Blue Cross is not offering individual insurance policies on the exchange for 2016.
“Our competitors don’t want to believe it necessarily, but we’re financially healthy,” Hickey said. “We’re going to be here for a very long time.”
Last week I made a valiant effort to convert my 2016 individual market percentage rate ncrease project into actual dollar figures--that is, I tried to figure out how much premiums are likely to increase, on average, in each state, in actual dollars. After all, saying that a policy premium "went up 50%" while another "only" went up 5% for the same person doesn't tell you much if the first one started out at $200/month and the second one was already $300/month. Unfortunately, I failed at doing this; way too many variables and too much missing data.
However, I am able to provide a sneak peak at average rates on the New Mexico individual and small group markets next year, for individual enrollees at 5 different ages, in all 5 different coverage regions:
When I last checked in on the ongoing saga between the New Mexico Insurance Commissioner and Blue Cross Blue Shield of New Mexico, BCBS was threatening to take their ball and go home if NM Insurance Commish John Franchini didn't cave and agree to let them jack rates up by 51% on the individual market (Franchini had agreed to a 24% hike instead).
Thousands of New Mexicans will need to shop for new health insurance plans later this year after a decision by Blue Cross Blue Shield to stop offering individual insurance plans through the state health exchange beginning Jan. 1.
...The letter said Blue Cross Blue Shield of New Mexico lost $19.2 million in 2015 on the 35,000 individuals covered by plans they purchased on and off the exchange.
...Blue Cross will offer a basic-level insurance plan outside the exchange in 2016, which will be available to all consumers at the same rate as in 2015.
Then, a few days later, the New Mexico state insurance commissioner announced the approved rate hikes for all 5 (or is it 6? see below...) of the companies in question. For BCBSNM (aka HCSC), they lopped the 57% hike down massively:
IMPORTANT:See this detailed explanation of how I've come up with the following estimated maximum requested weighted average rate increases for New Mexico.
As explained in the first link above, I've still been able to piece together rough estimates of the maximum possible and most likely requested average rate increase for the New Mexico individual market:
Again, the full explanation is included in the Missouri estimate linked at the top of this entry, but to the best of my knowledge, it looks like the companies with rate increases higher than 10% come in at a weighted 43.3% increase, but only make up about 62% of the total ACA-compliant individual market, with several other companies with approved increases of less than 10% (decreases in some cases) making up the other 38%.
This AP article provides snippets about a handful of states; it'd be nice if they just released the actual report so we could see the hard expansion numbers (as opposed to the total increase numbers, which are still obviously useful but don't distinguish between traditional Medicaid and ACA expansion enrollees):
In Kentucky, for example, enrollments during the 2014 fiscal year were more than double the number projected, with almost 311,000 newly eligible residents signing up. That's greater than what was initially predicted through 2021.
...At least 14 states have seen new enrollments exceed their original projections, causing at least seven to increase their cost estimates for 2017, according to an Associated Press analysis of state budget projections, Medicaid enrollments and cost details in the expansion states. A few states said they could not provide original projections.