Consumer Choice Continues to be a Hallmark of the Marketplace
ALBANY, N.Y. (March 14, 2018) -- NY State of Health, the state’s official health plan Marketplace, today released data showing 2018 health plan enrollment by insurer. Statewide, 12 health insurers offer Qualified Health Plans (QHP) to individuals and 15 health insurers offer coverage to Essential Plan (EP) enrollees through the Marketplace. Ten health insurers participate in all individual market programs offered through NY State of Health allowing consumers a smooth transition if their program eligibility changes. Throughout the 2018 Open Enrollment Period, most consumers had a choice of at least four health insurer options in every county of the State.
The Bipartisan Health Care Stabilization Act of 2018 (BHCSA) would make several changes to health care laws. It would:
Change the state innovation waiver process established by the Affordable Care Act (ACA),
Appropriate a total of $30.5 billion for reinsurance programs or invisible high-risk pools in the nongroup insurance market,
Appropriate funds for the direct payment for cost-sharing reductions (CSRs) through 2021,
Allow any enrollee in the nongroup market to purchase a catastrophic plan, and
Require some existing funding for operations in the health insurance marketplaces to be used specifically for outreach and enrollment activities in 2019 and 2020.
As regular readers will recall, after three years of full 3 month Open Enrollment Periods across every state, last year the Trump Administration slashed the official Open Enrollment Period in half, down to just 6 weeks, from November 1 - January 31 down to November 1 - December 15th.
In response, most of the state-based exchanges announced that they were sticking with a longer period anyway, ranging anywhere from a 7th week all the way out to the full 3 month period, in the case of California, New York and the District of Columbia...each of which kept things going all the way through January 31st as had become the norm.
California even went one step further, passing a state law specifically mandating a 3-month Open Enrollment Period for 2018 and beyond.
Until today, I've been operating on the assumption that they'd be sticking with the November/December/January schedule which had become the default.
What’s next: Alexander and Collins are hoping to get this proposal included in the omnibus spending bill Congress needs to pass this week. We should find out soon whether it's in or out.
I just did a light analysis of how many people would be helped or hurt by CSR funding in 2019 in Rhode Island, and concluded that at least 28% of exchange enrollees would see their premiums increase if CSR funding was restored, while only perhaps 2-3% would see their premiums drop.
So there you have the enrollment results of full-bore on-exchange silver-loading of CSR costs in one state. In all, 49,993 on-exchange enrollees with incomes up to 400% FPL chose plans other than silver. About 48,000 of them were subsidized. That's 31.2% of all enrollees, within striking distance of Aron-Dine's upper bound of 36% for all marketplace enrollees.
HealthSource RI, Rhode Island's ACA exchange, released preliminary 2018 Open Enrollment data awhile ago, but this morning they released their final, official demographic data breakout, and there's a lot going on here:
HealthSource RI sees 5% enrollment increase and nation leading lowest benchmark plan cost
State-based marketplace sees rise in enrollment of “young invincibles”
Under the Guise of “Health Insurance Stabilization,” Congress Should Not Axe Financial Help for Low-Wage Families
In negotiations over stabilizing the individual health insurance market, lawmakers are considering slashing federal health care assistance for low- and moderate-income consumers by more than $27 billion a year. In dollars terms, this would be a greater blow than completely eliminating, in one stroke, the Low-Income Home Energy Assistance Program, the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), the Child Care and Development Block Grant, the Community Development Block Grant, and federal grant programs for community-based mental health services and substance abuse prevention and treatment.
Health insurers and the Trump administration face a court decision shortly that will determine whether the government must pay insurers billions of dollars despite Republican efforts to block payments they view as an industry bailout.
Insurers have filed roughly two-dozen lawsuits claiming the federal government reneged on promises it made to pay them under the Affordable Care Act.
...It could also shape the outcome of other insurer lawsuits that would leave the government potentially owing as much as roughly $20 billion in past and future payments. Those cases, legal experts say, amount to the largest civil lawsuits ever.
Between the lines: This doesn't solve the partisan dispute over abortion language, as it'd bar plans that offer abortion coverage from receiving federal subsidies. But it hints that there's Republican support behind a set of policy changes that could substantially lower premiums ahead of the 2018 elections.
I wrote an extensive piece about the way abortion coverage is currently handled for ACA exchange policies back in October 2017:
Yesterday I came out against the pending ACA stability package because one of the 5 proposed provisions should be a flat-out dealbreaker for Democrats (the abortion ban), while another one is would hurt more people than it helps (CSR funding).
Today, I need to explain the problem with CSR funding in a bit more detail but to also note a new twist which makes it even more complicated...as well as taking note of a sixth provision being thrown into the mix by the GOP which, again, should be a dealbreaker for Democrats.
First up: CSR funding.
I'm on the record as being strongly in favor of a bill recently proposed by House Democrats Frank Pallone, Jr., Richard Neal and Bobby Scott which would repair, strengthen and expand the ACA in a half-dozen ways while also preventing or reversing another half-dozen types of sabotage of the ACA by the Trump Administration. Here's the full list of what would be included in what I've shorthanded "ACA 2.0":
