ACA Sabotage

2019 OPEN ENROLLMENT ENDS (most states)

Time: D H M S

 

Note: Most of this isn't limited to Michigan...nearly all of the items listed here could/should be applied in other states as well.

Dear Democratic nominees for Michigan State House and State Senate:

Hi there, and congratulations on your primary victory!

If you're familiar with me and this site, you probably know three things about me:

  • 1. I strongly support achieving Universal Healthcare coverage, and I'd ideally prefer to utilize some sort of Single Payer system as the payment mechanism to do so.

 

via Amy Lotven of Inside Health Policy:

Update: The court has instead opted to dismiss the case; but states can bring action again if circumstances change i.e. Admin blocks silver-loading in 2020 and beyond. IHP story TK @nicholas_bagley @charles_gaba taking comments ! https://t.co/cPHJlmehsH

— Amy Lotven (@amylotven) July 18, 2018

She's referring to this:

Dem AGs Ask Court To Put CSR Case On Hold In Light Of Silver-Loading

A few days ago I noted that Blue Cross Blue Shield of Tennessee, which holds over 50% of TN's ACA-compliant individual market, specifically noted in their individual market rate filings that while they're lowering rates by 10.9% on average in 2019, they had been planning on lowering rates considerably more prior to the bombshell announcement that CMS has decided to "freeze" Risk Adjustment fund transfers for an unknown period of time. Specifically:

“Our rate reduction would have been larger, but we had to account for added uncertainty in our rates due to indefinite suspension (the U.S. Centers for Medicare and Medicaid Services) placed on risk adjustment transfers between insurers,” said , said Mary Danielson, a BCBST spokeswoman. “Again, we were planning a larger reduction – around 18 percent – but needed to factor in the prospect of greater costs for 2019.”

Breaking out of Nevada...

The cost of plans through Nevada’s health insurance exchange are anticipated to only increase by an average of 1.9 percent next year in what the state’s insurance commissioner said is the lowest proposed rate increase from insurance companies since the Affordable Care Act went into effect in 2014.

The announcement, made by the Division of Insurance late Tuesday morning, comes amid ongoing uncertainty about the impact that Congress’s repeal of the Affordable Care Act’s individual mandate and federal rule changes for two types of non-ACA-compliant health plans will have on the individual market as a whole. Insurance Commissioner Barbara Richardson cautioned that the proposed rates are subject to change based on any action by the federal government and said the division is working “diligently” to review the proposed rates from insurance companies.

That 1.9% figure is slightly misleading, though, because...

Via the Colorado Division of Insurance:

DENVER (July 13, 2018) – The Colorado Division of Insurance, part of the Department of Regulatory Agencies (DORA), today released preliminary information for proposed health plans and premiums for 2019 for individuals and small groups. Colorado consumers can file formal comments on these plans through August 3.

2018 Companies Return for 2019
The same seven companies that offered on-exchange, individual plans are returning for 2019 - Anthem (as HMO Colorado), Bright Health, Cigna Health and Life, Denver Health Medical Plans, Friday Health Plans, Kaiser Foundation Health Plan of Colorado and Rocky Mountain HMO. And like in past years, this means that all counties in Colorado will have at least one on-exchange company selling individual health plans.

Holy guacamole. I've noted repeatedly that unlike last fall, when average rate increases of 20-30% or more were commonplace for ACA individual market policies (due mainly to Trump cutting off CSR reimbursement payments), the preliminary rate requests for 2019 are actually averageing quite a bit lower than originally expected; of the 20 or so states I've crunched the numbers for so far, the weighted average for unsubsidized premium hikes is hovering around the 10% mark.

At first glance, it may sound like Democrats have been overplaying their hand when it comes to the "individual mandate repeal/short-term plan expansion is causing massive hikes!" attack. However, the rate increases from deliberate sabotage are happening...they're just being partly cancelled out by other factors, including:

If you've followed this site for awhile, you may recall that about a year ago, I called out the Centers for Medicare & Medicaid (CMS) for trying to pull a fast one regarding the 2017 Open Enrollment Period data.

The short version is that they tried to make it look as though only 10.3 million of the 12.2 million people who selected Qualified Health Plans (QHPs) from the ACA exchanges actually paid their first month's premium and were actually enrolled (i.e., "effectuated"), or around 84%. They then tried using this "fact" as evidence of how the ACA was failing, etc etc, because this was supposedly down from 2016 levels.

The difference, as I noted at the time, is that the 2016 effectuation numbers were as of March, while the 2017 effectuation numbers were as of February. This made a big difference, because around 500,000 people who enrolled during 2017 Open Enrollment couldn't have been effectuated for February...because about half a million people enrolled between Jan. 16th - Jan. 31st, which meant their policies weren't even scheduled to begin until March.

Last week I noted that after slashing the marketing budget for HealthCare.Gov, by a whopping 90% (from $100 million to just $10 million) and cutting the Open Enrollment Period itself in half (from 3 months to just 6 weeks) and cutting the navigator/outreach budget by 41% (from $59 million down to $36 million), Trump's CMS Dept. was "considering" slashing the navigator budget for 2019 down further yet:

The Trump administration is considering cutting funding for ObamaCare outreach groups that help people enroll in coverage, sources say.

An initial proposal by the administration would have cut the funding for the groups, known as "navigators," from $36 million last year to $10 million this year. Sources say that proposal now could be walked back, and it is possible funding could remain the same as last year, but it is unclear where the final number will end up.

I've obviously gotten a bit behind with my "ACA 2.0 spreadsheet" project...

New law preserves Affordable Care Act measures for Hawaii residents

Gov. David Ige signed a new law on Thursday that ensures certain benefits under the Affordable Care Act will be preserved under Hawaii law.

Senate Bill 2340 retains several of the measures introduced in the Obama-era legislation, also known as Obamacare, including a clause that allows Hawaii adults up to 26 years-old to continue receiving health insurance under their parents.

The law also prohibits health insurance organizations from excluding coverage to those with preexisting conditions, or using an individual's gender to determine premiums or contributions to health insurance plans.

According to Louise Norris of healthinsurance.org, here's a more clear look at what SB 2340 does:

This morning, CMS released the 2017 Risk Adjustment Summary Report for the Individual, Catastrophic and Small Group markets. As I noted at the time, the total amount of money we're talking about being shifted around here is around $10.4 billion, with around $7.5 billion in the individual market, $2.9 billion in the small group market and just $42 million in the catastrophic market.

However...this isn't actually a matter of insurance carriers being owed $10.4 billion. Because of how Risk Adjustment (RA) works, it's actually half as much as that--around $5.2 billion is owed by some carriers to other carriers.

OK, I wasn't expecting this at 10:40pm on a Friday night, but here you go...via Stephanie Armour and Anna Wilde Mathews of the Wall St. Journal:

Trump Administration Expected to Suspend ACA Program Related to Insurer Payments

The Trump administration is expected to suspend an Affordable Care Act program that plays a key role in the health law’s insurance markets, a move that could deal a financial blow to many insurers that expect payments.

The suspension of some payouts under the program, known as risk adjustment, could come in the wake of a recent decision by a federal judge in New Mexico, who ruled that part of its implementation was flawed and hadn’t been adequately justified by federal regulators, people familiar with the plans said.

Whew! Georgia only has 4 carriers participating in the individual market, but tracking down some of the data was a royal pain in the butt, especially Ambetter/Centene, which not only buried the numbers I needed inside a whopping 1,900-page PDF file, but the actual average requested rate increase wasn't even included; for that I had to check a different file. Yeesh.

The good news is that carriers in Georgia are only requesting around a 6.1% average rate increase for ACA-compliant individual market policies next year.

The bad news is that if it weren't for the ACA's individual mandate being repealed and the Trump Administration's expansion of #ShortAssPlans, 2019 premiums would likely be dropping by around 5.8% instead.

Last summer, as part of his blatant and openly-declared attempt to undermine and sabotage the Affordable Care Act, Donald Trump's HHS Dept. slashed the marketing budget for HealthCare.Gov, the federal ACA exchange, by a whopping 90% (from $100 million to just $10 million), while also cutting the navigator/outreach budget by 41% (from $59 million down to $36 million). On top of this, they also proceeded to confuse the hell out of the grantees of those remaining funds by not providing any information or details before sending out the funds...and then changing their minds at the last minute in many cases and pulling the checks literally moments before they were supposed to be put in the mail. They also slashed the Open Enrollment Period itself in half while they were at it, from 3 months down to just 6 weeks.

*(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...

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