Washington State: No bare counties in 2019; 15% drop in ACA-compliant individual market?

2018 MIDTERM ELECTION

Time: D H M S

This just in from the Washington State Insurance Commissioner's office...

Eleven health insurers file for 2019 individual market: No bare counties

May 25, 2018

OLYMPIA, Wash. – Eleven health insurers filed 88 health plans for Washington state’s individual market yesterday, and all 39 counties will be covered in 2019.

The proposed rate changes are not public until 10 days after the OIC has determined the filings are complete. Release of the proposed rate changes is targeted for June 4. 

“We can all breathe a sigh of relief knowing consumers in every county who need coverage will have access to a health plan in 2019,” said Insurance Commissioner Mike Kreidler. “Obviously, how much premiums may change and any increases to out-of-pocket costs are still key concerns, but I’m grateful that we can assure people that coverage is available, regardless of where they live.” 

Last year, two counties – Klickitat and Grays Harbor – initially had no option for individual health insurance. Kreidler reached out to the insurers to see if any would reconsider and Premera Blue Cross stepped in to cover Grays Harbor County and Bridgespan and Molina covered Klickitat County.

This year, Premera made assurances it was prepared to offer coverage should any county be without an individual health insurer for 2019. About 300,000 people in Washington buy their own individual health insurance coverage. Most work for employers who don’t offer health insurance, are self-employed or are early retirees. 

Kreidler’s office will review all proposed health plans and their proposed rate changes over the next several months with decisions coming in the fall.

A bit of a bummer that we have to wait another 10 days for the rate changes, but yes, nice to know that every part of the state should have at least one carrier next year.

Also noteworthy is the 300,000 figure. According to Mark Farrah Associates, there were about 362,000 people on the individual market as of a little over a year ago...but that included Grandfathered enrollees, which I confirmed were down to fewer than 8,400 as of a year ago (Washington state didn't allow Transitional enrollees). This suggests that Washington State's ACA-compliant individual market has dropped from around 353,000 to 300,000 in the past year...or roughly 15%.

On-exchange enrollment actually increased by 8% (over 17,000) this year, which means that off-exchange enrollment must have dropped by a good 70,000 or so...from around 157,000 as of March 2017 to around 87,000 today (after non-payment and attrition, it should be around 213,000 exchange-based + 87,000 off-exchange = 300,000 total).

In other words, in Washington State, this suggests that the exchange-based market has grown by 8% since last year while the off-exchange market has dropped by a whopping 44% to get an overall drop of 15%. This also suggests that the Silver Switcharoo effect may not have been that great in WA after all.

UPDATE: As "thinker" notes in the comments, a chunk of the 8% on-exchange growth may simply be people who were enrolled off-exchange last year switching to an on-exchange plan. If you earn between 300-400% of the Federal Poverty Line ($36K - $48K for one person), you'll receive tax credits to cover the difference between 9.6% of your income and whatever the full-price premium is for a Silver plan. Premiums may have been under 9.6% of that last year for many of these folks but grew to over 9.6% this year, so it would make sense for them to move on exchange.

I'm sure not all of the on-exchange growth (17,600 people) was due to this, but if it was, that would account for up to 1/4 of the off-exchange reduction.