Alabama

When UnitedHealthcare announced last month that they were making good on their threat last fall to pull out of the individual market in over two dozen states next year, it caused shockwaves across the health insurance industry. It is an important development, as around 800,000 people will be impacted.

When Humana announced last week that they plan on pulling out of the individual market in at least 5 states next year, it was interesting and a bit of a bummer, but not nearly as earthshattering, because only about 25,000 people will have to shop around and find a new carrier.

Today, it is my duty to announce that Celtic insurance has also decided to pull out of the entire individual insurance market (both on and off-exchange) across at least 6 states, including:

This is really just a summary of my last 4 posts. I've combed through the SERFF databases for every state which uses the system for rate filings, and while very few have the actual 2017 rate filing requests listed yet, at least 4 of them have official individual market exit letters submitted for 2017 from Jane Rouse, the Product Compliance Process Owner for Humana Insurance Co:

This list may grow as additional state filing data and/or press releases come out from Humana, but assuming these are the only 4 states Humana is bailing on, the news isn't quite as bad as it appears at first.

To keep things in perspective, add the 4 numbers above up and it's 25,512 people across 4 states with a combined population of 21.8 million. Put another way, these 25.5K people represent only 2.9% of the 875,700 people Humana currently has enrolled in individual policies (both on & off exchange) nationally.

To be clear, I'm not saying this is a good development; when you combine it with the recent UnitedHealthcare Dropout Odometer it's more of a drip-drip-drip sort of thing. But it isn't disasterous for the exchanges either (at least not yet).

UPDATE: I've been informed by a reliable source that Humana is also dropping out of the individual market in Nevada next year, although I don't have any actual enrollment data there. Humana is not currently participating on the Nevada exchange, however, so any dropped enrollments would be OFF-exchange only. In fact, I'm pretty sure that the only individual market enrollees Humana has in Nevada are grandfathered policies anyway, so the numbers should be pretty nominal there.

Just like in Wisconsin, Humana appears to be pulling up stakes on the individual market in Alabama as well...but unlike Wisconsin, Humana is operating on the ACA exchange this year. With UnitedHealthcare already having announced that they're leaving Alabama as well, Humana dropping out in 2017 will leave Blue Cross Blue Shield of AL as the only individual market carrier operating on the exchange in the state unless someone else jumps in (although I believe there are some carriers offering individual plans off-exchange only):

Presented without comment, other than a link to my prior related story:

Alabama's Republican governor says he is considering expanding Medicaid under ObamaCare in his state.

"We are looking at that,” Gov. Robert Bentley said Thursday, according to The Associated Press. “We have not made a final decision on that yet, exactly how that would work.”

Bentley indicated that expanding Medicaid, the government health insurance program for the poor, could help get more doctors into rural parts of the state.

"I am concerned about the plight of the working poor,” he said. “If doctors are not paid for seeing those patients, doctors will not go to rural Alabama, because you can't expect a doctor to go to rural Alabama and lose money.”

Gee, ya think? Still, I'll take it...

As with many other states, I'm working with limited enrollment and rate change data here, so plenty of caveats abound. However, Alabama's 2014 individual market was only around 206,000 people, and the ACA-compliant market should be roughly the same this year. I can account for 176,000 of that, so the remaining 30K or so are unknown other than being split among a half-dozen companies which requested rate changes of below 10% increases.

Assuming around 7% on average for the balance, Alabama residents are likely looking at roughly a 24.4% rate hike...assuming they stick with their current plans.

In other words: Shop around, shop around, shop around!

I've posted a few times before about the ACA Medicaid expansion situation in some deep red states; Tennessee, Utah and Wyoming among them:

Two of the most heavily Republican states, Utah and Wyoming, appear to be moving closer to an expansion of Medicaid under the Affordable Care Act. Other GOP-dominated states, like Indiana and Tennessee, are also looking more closely at it, despite the hostility of their party’s leaders toward Obamacare.

...Gov. Matt Mead of Wyoming, where Republicans hold 78 of 90 seats in the legislature, acknowledged his opposition to Obamacare but said the statehad to be realistic by embracing Medicaid expansion in one form or another. “I don’t think we can say to those people in Wyoming who are working [and] who cannot get insurance that we’re not going to do anything,” he said.

...While the odds for expansion in Wyoming remain uncertain, Utah seems likely to move in the coming months. There, Gov. Gary Herbert made the case on moral grounds — as a duty to help people he described as “our neighbors, our friends and our family members.”

This one is a bit squirrelly to suss out, and I'm not sure that I've done so correctly, so bear with me. According to the (very short) article:

MONTGOMERY, Ala. (AP) — State officials say Alabama Medicaid's monthly enrollment has topped 1 million for the first time.

Officials said Thursday that a review of data for the first five months of the year show the milestone happened in February. Officials attribute the increase to a federally required transfer of children from the state's All Kids program and changes in how Medicaid eligibility is determined. Officials say the numbers also reflect the first enrollment of individuals who applied for coverage through the federal health exchange under the federal Affordable Care Act.

Enrollment has remained above 1 million in March, April and May.

OK, this doesn't give a complete picture of Alabama's exchange QHP payment rate for two reasons: First, because the 82% figure is a blend of 85K via the exchange and another 20K off-exchange enrollees; second, because while BCBS does have the lion's share (87%) of exchange QHP enrollees in the state, there's still another 12,870 QHPs (out of the 97,870 total in Alabama) which belong to other insurance companies, which may have a higher or lower payment rate to date.

Having said that, assuming that the ratios are representative on both counts, it looks like about 82% of Alabama's enrollees have paid so far:

Some 82 percent of those enrolling in Blue Cross and Blue Shield of Alabama through the exchanges have paid their first month's premium, mirroring figures released today by other large insurers in preparation for congressional testimony.

"We have enrolled over 105,000 members both on and off the federally facilitated exchange in Alabama," said Koko Mackin, BCBS of Alabama said in an email to Al.com. "Over 85,000 members enrolled through the federal exchange, while another 20,000 signed up directly with Blue Cross -- 82% of our exchange enrollees have paid their first month’s premium."

Short and sweet...Alabama was at 55,034 as of 3/01, so this appears to be a spike of nearly 22,000 QHPs. It's technically feasible that the 77K figure includes the 18K Medicaid enrollees which Alabama (a non-expansion state) has added, but I doubt it; that would only leave 4K QHPs in March, and they had over 11K in February, so I think I'm safe here:

So far 77,000 Alabamians have signed up for health insurance through the marketplace.

UPDATE: On the down side, I was off by 4% this time around.

On the up side, I UNDERESTIMATED:

Actual Feb. enrollments: 942,833, for a total of 4,242,325 thru 3/01/14.

Sarah Kliff at Vox just announced that the February HHS report is expected to be released today at around 4:00pm. A few items in anticipation of that:

  • As I've noted several times, I'm projecting the report to total around 902,000 exchange-based private QHP enrollments for the month of February (technically 2/02 - 3/01)
  • If accurate, this would bring the cumulative total of exchange-based private QHP enrollments to 4.202 million (from 10/1/13 - 3/01/14)
  • From the data I have, the average daily enrollment rate in February was almost identical to that of January, which had about 1.146 million QHP enrollments. HOWEVER, the January report included five weeks of data (12/28 - 2/01), while the February report will only include four weeks (2/02 - 3/01). Therefore, even at the same daily average, it'll be about 20% lower no matter what.
  • Don't be surprised if Peter Lee of CoveredCA decides to steal some thunder by announcing that California has enrolled 1,000,000 QHPs all by itself either today or tomorrow. However, that would include the past 10 days, while the HHS number will only run thru 3/01.
  • If you want to get REALLY specific, call it 902,800 and 4,202,292.
  • I've been dead-on target 6 times in a row without hyping up my projections beforehand. This time I am hyping myself up beforehand, so I'll probably be way off...but as long as I've UNDERestimated the tally, I'll be perfectly fine with that...
  • The report will be released in about 5 minutes, but my kid gets home from school in about 10, so it'll be a good 20 minutes before I can really post anything. Feel free to follow Sarah Kliff of Vox in the meantime!

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