Charles Gaba's blog

This just in from the Idaho Insurance Dept:

Individual Medical Plans

The Department of Insurance received preliminary 2020 health plan information from insurance carriers on June 1 and began reviewing the proposed plan documents and rates for compliance with Idaho and federal regulations. The Department of Insurance does not have the authority to set or establish insurance rates, but it does have the authority to deem rate increases submitted by insurance companies as reasonable or unreasonable. After the review and negotiation process, the carriers submit their final rate 2020 increase information. The public is invited to provide comments on the rate changes. Please send any comments to Idaho Department of Insurance.

NOTE: This post re. North Carolina's 2020 individual market premium rate change is incomplete because it only includes one of the three carriers participating in NC's market (Blue Cross Blue Shield of NC). The rate change requests for Cigna and Centene haven't been released yet.

Normally I'd wait until I had data for the other two as well, but BCBSNC held around 95% of the state's Individual Market share last year, with Cigna holding the other 5% (Centene was a new entry to the market, so they didn't have any of it). I don't know how much the relative share has changed this year, but I'm assuming that BCBSNC still holds the lion's share of the total.

That being said, BCBSNC just posted their own preliminary rate filing summary on their corporate blog:

Blue Cross NC is decreasing 2020 Affordable Care Act (ACA) rates by an average of 5.2 percent for plans offered to individuals and an average of 3.3 percent for plans offered to small businesses with one to 50 employees. With this reduction, we take 238 million steps towards more affordable care in North Carolina.

The good news about the Ohio Insurnace Dept. is that they make it easy to find out which insurance carriers are participating on the ACA market and what the overall, weighted premium change is statewide.

The bad news is that they don't break out that statewide average by carrier rate changes, nor do they make it easy to find out the actual enrollment in the individual carriers...even on the SERFF database, they don't post the relevant filing forms until much later in the year, and tend to redact the critical data.

Still, the big number in the Buckeye State is a 7.0% average premium decrease year over year for 2020:

Ohio Health Insurance Exchange 2020

This Just In from the Pennsylvania Insurance Dept:

Insurance companies offering individual and small group health insurance plans are required to file proposed rates with the Pennsylvania Insurance Department for review and approval before plans can be sold to consumers. The Department reviews rates to ensure that the plans are priced appropriately -- that is, they are neither excessive (too high) nor inadequate (too low) -- and are not unfairly discriminatory.

Rates reflect estimates of future costs, including medical and prescription drug costs and administrative expenses, and are based on historical data and forecasts of trends in the upcoming year. In its review, the Department considers these factors, as well as factors such as the insurer's revenues, actual and projected profits, past rate changes, and the effect the change will have on Pennsylvania consumers. For more information on this process, watch our How Are Health Insurance Rates Decided?Opens In A New Window video.

So, I wrote my first Op-Ed piece for the Washington Post yesterday...

Harris’s rollout Monday was met with swift criticism from both the Biden camp, which called it “A Bernie Sanders-lite Medicare for All,” and the Sanders camp, which insists Harris “can’t call [her] plan Medicare for All.”

In saying this, the Sanders campaign is effectively trying to lay a copyright claim to Medicare-for-all, as if it, and only it, can define what it means. The reality is far less clear — and depending on your perspective, it could be Harris’s proposal that is more justified in claiming the Medicare-for-all branding.

I'm not going to overquote my own piece, but this has led to some backlash against me, so for the record:

Last month I noted that Maine's Bureau of Professional & Financial Regulation released their preliminary 2020 rate filings for the Individual and Small Group markets. At the time, the three carriers on their Indy market were requesting average rate increases of around 4.7% next year.

Well, the final/approved rate changes won't happen for another month or so, but it looks like the carriers themselves have sliced their unsubsidized 2020 rates down of their own volition:

Maine’s three providers of individual health insurance on the Affordable Care Act marketplace have revised their rate requests for 2020, significantly lowering their projected rates.

Previously, the insurers had sought modest average rate increases of 1 percent to 8 percent. Under the revised filings, two of the three insurers are now requesting decreases for individual plans, and the other is seeking an increase of less than 1 percent.

The Arkansas Insurance Dept. just posted their preliminary 2020 individual and small group market premium rate change requests. For the most part it's pretty straightforward: Individual market premiums are increasing about 2.3% statewide, while small group plans are going up 6.5% overall.

However, there's two interesting things to note about Arkansas' individual market: First, unlike most states where over 70% of enrollees do so through the ACA exchange, in Arkansas it's more like 20%, with nearly 80% are enrolled off-exchange. The main reason for this is the state's unique "Private Option" Medicaid expansion waiver, in which around 252,000 residents who would otherwise be enrolled in Medicaid itself are instead enrolled in enhanced ACA individual market policies...with the state paying for their premiums.

(IMPORTANT: As my friend Shawn Pierce keeps pointing out, the phrase "Medicare for All" has two very different meanings...one is the brand "Medicare for All", which simply refers to any healthcare plan which ensures 100% universal, comprehensive healthcare coverage for everyone; the other is the specific bills introduced by Sen. Bernie Sanders and/or Rep. Pramila Jayapal, which would indeed completely eliminate private major medical insurance for 100% of the population as well as completely eliminating all out-of-pocket costs in favor of 100% federal public funding).

For months now, California Senator and Presidential candidate Kamala Harris has repeatedly struggled with how to address her support of Bernie Sanders' 100% mandatory, $0 out-of-pocket-cost, 100% comprehensive "pure" single payer "Medicare for All" healthcare bill.

A new analysis from the National Bureau of Economic Research has quantified something which healthcare advocates have been arguing for years:

The United States could have averted about 15,600 deaths if all 50 states expanded Medicaid under the Affordable Care Act, new research suggests.

...As of 2019, 36 states and the District of Columbia have adopted the Medicaid expansion, and 14 have not.

Four researchers — University of Michigan economist Sarah Miller, University of California, Los Angeles public health scholar Laura Wherry, National Institutes of Health’s Sean Altekruse and Norman Johnson with the US Census Bureau — used that difference to study what happened to people’s health outcomes in states that expanded the program compared to those that did not. A new working paper published by the National Bureau of Economic Research details their results.

FULL DISCLOSURE: Since June 2019, I've been contracted with the Center for American Progress to provide healthcare data analysis & advocacy on their behalf on a part-time basis.

UPDATE: My contract with CAP ended on Nov. 30th, 2020 (on a positive note--I knew going in it was a temporary arrangement and enjoyed working with them).

NOTE: This is not an in-depth analysis, for three reasons:

  • Third, I have a bit of a personal/household crisis to deal with this week (don't worry...no one's sick, dead or getting divorced, but our house is in need of some serious attention)

If you've been reading my site for more than a couple of years, you know that back in February 2018 I fell in love (well, mostly) with a new Universal Healthcare Coverage proposal from the Center for American Progress called "Medicare Extra for All" or simply "Medicare Extra".

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