Charles Gaba's blog

 

Note: This is a follow-up to a post I wrote back in early May which was itself based on an earlier analysis by the folks at the Kaiser Family Foundation.

For weeks now, I've been painstakingly analyzing and plugging in the preliminary 2019 rate change data for ACA-compliant individual market as each state submits their filings. As of today, I've compiled data for 18 states (+DC), comprising perhaps 40% of the total ACA individual market, give or take. The table below shows where things stand at the moment.

Those yellow and manilla cells at the bottom are not a typo: To the best of my estimates so far, the insurance carriers across these 19 markets are asking for average 2019 unsubsidized premium rate increases of around 10-11%...however, as far as I can tell, they would be keeping rates FLAT year over year (on average), for the first time since the ACA launched, if not for three sabotage efforts by Donald Trump and Congressional Republicans: Repeal of the ACA's individual mandate, and Trump's removal of restrictions on non-ACA compliant "Short-Term, Limited Duration" and "Association" plans, which I've shorthanded as simply #ShortAssPlans....and in fact would actually be dropping in quite a few states (or, in the case of Minnesota, dropping more than they already are set to with those factors):

Yeah, that's right...I turn 48 today. I've never been shy about self-promotion, and I am still trying to turn my "healthcare data/policy analysis & snark" thing into a full-time career, so I thought about the best way to approach it.

Here's what political candidates often do:

"It's Candidate X for Congress's 48th Birthday! Help celebrate by donating $48 or for 48 people to pledge a few bucks per month!"

(The difference is that in this case the money would be going to support my work here at ACASignups.net, not a political campaign. And no, it's not tax deductible.)

I'm angling folks more towards the smaller, monthly support model since that makes things more consistent/steady, but I'm not gonna say no to one-time support either!

Florida is the 3rd largest state in the country, but has nearly the same number of ACA-compliant individual health insurance policy enrollees as California (around 2.0 million people if you subtract out grandfathered and transitional enrollees, vs. California's 2.1 million) even though Florida's total population is only 53% of California's (about 20.9 million vs. 39.5 million). Put another way, nearly 13% of Florida's non-elderly population is enrolled in the individual market, which is about twice as high as the natoinal average.

Add to this the fact that Florida is also the largest swing state politically, and people will be watching Florida's ACA exchange/premium situation very closely this fall.

Kentucky's 2019 preliminary Rate Filings have been posted, and they're pretty straightforward: Like this year, there will only be two carriers offering policies on the KY individual market in 2019: Anthem and CareSource, with roughly a 46/54 market share split.

The overall average requested rate increase is around 12.2% between the two. Neither carrier states just how much of their requested increase is due to mandate repeal or #ShortAssPlans (CareSource did list it...but then redacted it from public view). The Urban Institute projected around an 18.7 percentage point impact; 2/3 of that is around 12.5 points, so that's what I'm assuming until further notice.

Assuming that's accurate, that means that if not for the mandate/shortassplan sabotage factors, Kentucky carriers would be keeping unsubsidized 2019 premiums flat year over year (or even dropping them a smidge).

Hmmm...extremely thin detail here, but I'll take what I can get for the moment:

Ohio Health Insurance Exchange 2019

The Affordable Care Act (ACA) requires that every state have an exchange where consumers can buy individual health insurance policies. In Ohio, the federal government runs the health insurance exchange. Ohioans who do not have health insurance through their employer, Medicare or Medicaid may be eligible to purchase coverage through the exchange. Open enrollment for coverage next year (2019) begins November 1, 2018. Below is preliminary data based on the filings submissions of insurers in Ohio. Once filings are approved in late summer/early fall, final information will be posted.

Ohio’s Health Insurance Market (2018–2019)

In 2018, 8 companies sold health insurance products on the exchange in Ohio and 42 counties had just one insurer with an additional 20 counties having only two.

Welp. There you have it. Via Jonathan Oosting of the Detroit News:

Snyder signs 80-hour Medicaid work requirement law

Most adult Medicaid recipients who receive health care insurance through the state’s Healthy Michigan plan will be required to work at least 80 hours per month or risk losing coverage under a new law signed Friday by Republican Gov. Rick Snyder.

Five years after he led the push to expand Medicaid eligibility under the federal Affordable Care Act, Snyder signed the new work requirements over protests from Democrats and advocacy groups who decried it as a legislative effort to strip health insurance from low-income residents.

...“The original estimates were that 400,000 people without health care would be able to obtain it after the creation of Healthy Michigan, and today more than 670,000 people have coverage. I am committed to ensuring the program stays in place and that Michiganders continue to live healthier lives because of it.”

Thanks to Maanasa Kona of the Center on Health Insurance Reforms at Georgetown for the heads up:

For the first time since 2014, the # enrolled in individual health plans in the first quarter of the calendar year in NJ went down from the previous year. Commissioner Caride blames the current administration's actions. https://t.co/xuuGLQV7BE pic.twitter.com/rGNpfx2IYS

— Maanasa Kona (@MaanasaKona) June 22, 2018

Here's the press release and table:

Health Insurance Enrollment in NJ Individual Market Down 10 Percent in First Quarter of 2018

Reduced Enrollment Demonstrates Importance of Policies Aimed at Stabilizing the Market, Increasing Access to Affordable and Quality Coverage

SEE UPDATE BELOW

WARNING: As far as I can figure, Texas's ACA-compliant individual market totals somewhere around 1.4 million people (Mark Farrah Associates estimated the entire individual market at 1.6 million a little over a year ago; of that I estimate roughly 180,000 were enrolled in grandfathered or transitional plans). The breakout as of today should be roughly 1.1 million on-exchange enrollees and perhaps 300,000 off-exchange.

Unfortunately, while the SERFF database shows 2019 listings for most of the 11 carriers which offer ACA policies in Texas this year, it only actually has the filings posted for 3 of them so far: CHRISTUS, Sendero and FirstCare Health Plans (aka SHA, LLC). Even then, those three carriers hold a pretty small share of the market, totalling just 65,000 enrollees. That means I only have actual 2019 rate data for about 5% of the ACA market available so far.

The Indiana Insurance Dept. has released the preliminary rate requests for 2019 insurance policies on the ACA individual and small group markets.

Like last year, there's only three carriers participating in Indiana's individual market: CareSource and Celtic (aka Ambetter) will again be available both on and off the ACA exchange, while Anthem will only be offering a single Catastrophic plan on the off-exchange market in just five counties:

The overall average rate increase for 2019 Indiana individual marketplace plans is 5.1%. CareSource and Celtic (MHS/Ambetter) have filed to participate in the 2019 Indiana Individual Marketplace. The Department of Insurance anticipates that all 92 counties in Indiana will be covered by one or more insurance company. CareSource plans to cover 79 counties. Celtic (MHS/Ambetter) plans to increase its coverage from 43 counties in 2018 to all 92 counties in 2019.

Anthem has filed to offer a 2019 Off-Marketplace plan in Indiana. This plan is a catastrophic plan and is offered only in Benton, Jasper, Newton, Warren and White Counties.

HHS just blocked us from entering its facility in Homestead, Florida to check on the welfare of the children being held here. They are obviously hiding something, and we are going to get to the bottom of this. pic.twitter.com/q4m6Zd0ck2

— Senator Bill Nelson (@SenBillNelson) June 19, 2018

An HHS official tells @weijia that there will NOT be special efforts made to reunite children who have already been separated from their families bc of the Zero Tolerance Policy, despite Trumps EO. Process will proceed for minors currently in the unaccompanied children program.

— Jacqueline Alemany (@JaxAlemany) June 20, 2018

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