Charles Gaba's blog

2018 MIDTERM ELECTION

Time: D H M S

For nearly a year, healthcare wonks like myself, David Anderson, Andrew Sprung and Louise Norris have been heavily getting the word out to promote not just the "Silver Loading" CSR-load workaround, but an even more clever variant which I've coined "the Silver Switcharoo" which takes the concept of Silver Loading and goes one step further.

It gets a bit complicated, but here's my explainer of how the Silver Switcharoo works for ACA individual market policies.

The bottom line is that in theory/on paper, just about everyone either comes out ahead or at least is no worse off if they use silver switching:

*(OK, these are technically only "semi-approved" rates...there could still be some additional tweaks later on after public comment, etc.)

Oregon was the fourth state which I ran a preliminary 2019 rate increase analysis on back in May. At the time, I concluded that insurance carriers were requesting a weighted average increase of 10.5% for ACA-compliant individual market policies next year. I knew that Oregon's state-based Reinsurance program was helping keep that average down to some degree, but I didn't know exactly how much of a factor it was.

I also knew that efforts to sabotage the ACA by Donald Trump and Congressional Republicans would play a major role in increasing 2019 rates: Repeal of the individual mandate is a big factor, along with the unnecessary 1-point increase in the state exchange fee being imposed on Oregon and the other four states which run their own exchange but "piggyback" on HealthCare.Gov's technology platform.

 

*As I explained 3 years ago:

Basically, Republicans have gone from saying "screw the poor" to "OK, you can see a doctor but only if you dance for me first."

ca·pri·cious (kəˈpriSHəs,kəˈprēSHəs/adjective): given to sudden and unaccountable changes of mood or behavior.

"a capricious and often brutal administration"

synonyms:fickle, inconstant, changeable, variable, mercurial, volatile, unpredictable, temperamental

HUGE. This doesn’t just impact Kentucky, it also has implications for Michigan, Ohio, Arkansas, Indiana...

This article from KTVQ is excellent for my purposes. It clearly and cleanly plugs in just about all of the hard numbers I need to run my rate hike analysis: Which carriers are participating in the 2019 ACA individual market; how many current enrollees each carrier has (both on and off the exchange); and the exact average increase each one is requesting for next year!

Health insurers selling individual policies on the “Obamacare” marketplace in Montana are proposing only modest increases for 2019, on average – or, no increase at all.

State Insurance Commissioner Matt Rosendale released the proposed rates Thursday, with Blue Cross and Blue Shield of Montana proposing an average increase of zero – and a 4.9 percent decline for small-group policies.

The other two companies selling policies on the online marketplace, PacificSource and the Montana Health Co-op, proposed average increases of 6.2 percent and 10.6 percent for individual policies, respectively, and lesser increases for small-group policies.

A couple of days ago, the nonpartisan Kaiser Family Foundation posted an important new analysis (actually a follow-up version of an earlier one they did in May) which proved, in several different ways, that after years of turmoil, the ACA's individual market had finally stabilized as of 2017...or, at least, it would have if not for the deliberate sabotage efforts of one Donald J. Trump and several hundred Congressional Republicans. This included hard numbers for the first quarter of 2018 which showed the trend continuing in a dramatic fashion.

Following up on that, they went further yesterday and posted a whole bunch of handy raw individual market data for the 2011 - 2017 calendar years at the state level, including the average gross profit margin per member per month as well as the share of premiums paid out as claims in every state (except, frustratingly, California).

This Just In...

State’s Market Stability Workgroup Recommends Immediate Action to Protect Rhode Islanders from Federal Threats to Health Insurance Access and Affordability

Posted on June 27, 2018 | By HealthSource RI

EAST PROVIDENCE, R.I. (June 27, 2018) – Rhode Island must act “without delay” to protect consumers from rising health coverage costs brought on by federal policy changes according to a report issued to Governor Raimondo by the state’s Market Stability Workgroup.

“People representing a wide variety of viewpoints engaged in lively discussions over the course of 8 weeks,” said Workgroup co-chair Bill Wray, Chief Risk Officer at the Washington Trust. “The fruits of those discussions are in this report. All of us – consumer advocates, business groups, health insurers and providers – were able to broadly agree on how best to protect Rhode Island’s insurance markets.”

*(technically Vermont was the third to do so, but theirs doesn't kick into effect until 2020, and they haven't even crystalized exactly what form it would take anyway.)
**(yeah, I know very well that DC isn't actually a state, but it's pretty awkward to put "state and/or territory" in the headline.)

I realize that 110% of the news/media/political attention is on the bombshell announcement that Supreme Court Justice Anthony Kennedy is retiring at the end of July, but there are other things going on as well, so I'll do my best to soldier on...

More big health care action at the state level: yesterday the DC Council passed what would be the nation's third state-level individual mandate, after Mass. and NJ.https://t.co/BmtnDAQvVp

— Jason A. Levitis (@jasonlevitis) June 27, 2018

The Kaiser Family Foundation runs a monthly, national tracking poll which is considered one of the Gold Standards when it comes to healthcare policy surveys. Here's the methodology for their June survey:

This Kaiser Health Tracking Poll was designed and analyzed by public opinion researchers at the Kaiser Family Foundation (KFF). The survey was conducted June 11th–20th 2018, among a nationally representative random digit dial telephone sample of 1,492 adults ages 18 and older, living in the United States, including Alaska and Hawaii (note: persons without a telephone could not be included in the random selection process). Computer-assisted telephone interviews conducted by landline (319) and cell phone (1,173, including 793 who had no landline telephone) were carried out in English and Spanish by SSRS of Glen Mills, PA.

 

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.”

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