Arizona

2018 MIDTERM ELECTION

Time: D H M S

The Arizona insurance department posted their final, approved 2019 premium rate changes last week. There's only slight changes to the preliminary/requested rate changes from back in August, which averaged around a 5.3% rate reduction overall.

The final unsubsidized rates are down about one point more, down 6.3% from 2018 rates. However, as all three current carriers clearly noted in August, the repeal of the ACA's individual mandate and expansion of short-term and association health plans (aka #ShortAssPlans) still caused a significant premium increase, which means without those factors, 2019 rates would likely be down significantly more...likely nearly 20% instead of 6.3%:

Arizona has only three carriers offering individual market policies next year. Blue Cross Blue Shield of AZ has nearly 40,000 enrollees and is keeping rates virtually flat, but specifically states that yes, they baked in extra costs to account for Congressional Republicans repealing the ACA's Individual Mandate and due to Trump's expansion of #ShortAssPlans (see screenshot below).

Centene is dropping rates by over 5 points. I don't know their exact enrollment/market share, so I'm forced to assume it's similar to last year's 95,000. Again, they call out both #MandateRepeal and #ShortAssPlans, but don't include a specific percentage for either (they did, but it was redacted in the public filing).

Finally, Cigna is dropping their 2019 premiums by a whopping 18.2% even with sabotage factors, which again are referenced in the filing. I don't know their enrollment either, but amd assuming it's roughly 16,000 since Arizona's total ACA indy market is around 150,000 people.

To the best of my knowledge, there are only 2 insurance carriers offering ACA-compliant insurance policies in Arizona next year: Blue Cross Blue Shield of AZ and Centene (branded as HealthNet).

Back in early August, BCBSAZ announced that they were asking for a relatively modest 7.2% rate increase next year in the 13 counties (out of 15 total) where they were offering individual plans. They also explicitly stated that if it weren't for their concerns over whether or not the Trump Administration would guarantee reimbursing their CSR expenses, they'd be keeping the 2018 rates flat year over year. Granted, this is after a massive rate increase for 2017, but it was still welcome news, and once again underscored how much damage the Trump sabotage factor is.

This isn't a full analysis, since I only have 2018 rate hike data for one of Arizona's carriers so far...on the other hand, AZ only has a couple of carriers on the individual market these days anyway. From AZCentral:

The Affordable Care Act insurer in 13 of Arizona's 15 counties plans to raise average rates across all plans a moderate 7.2 percent next year.

But Blue Cross Blue Shield of Arizona officials said the rate increases would be flat if President Donald Trump's administration did not plan to eliminate a key Affordable Care Act funding source.

7.2% isn't bad at all...of course, that comes after last years massive 57% average rate hike. Still, 0% would obviously be much better than 7%...

Trump suggested in a weekend tweet that " ... bailouts for insurance companies and bailouts for members of Congress will end very soon" unless Congress acts quickly on a new health bill.

Of the 31 states which have expanded Medicaid under the Affordable Care Act, only a handful issue regular monthly or weekly enrollment reports.

I noted in February that enrollment in the ACA's Medicaid expansion program had increased by around 35,000 people across just 4 states (LA, MI, MN & PA).

It's early June now, so I checked in once more, and the numbers have continued to grow. I have the direct links for 5 states now (including New Hampshire)...

OK, this appears to be quickly turning into my next project thing. The methodology here is pretty much the same as the other states; the only major difference is that while I do know the total Medicaid enrollment for each county (as of December 2016), I don't have that broken out between traditional and expanded Medicaid. Fortunately, I have a hard state-wide number for that: Around 398,000, or roughly 20.8% of the state-wide total. I've therefore multiplied each county number by 20.8% to get a rough estimate of the ACA expansion tally for each.

Like Texas, I'm also no longer expecting Arizona to beat last year's Open Enrollment total by much. Assuming 209K QHP selections, there should be around 125K indy market enrollees and 399K Medicaid expansion enrollees who'll be in a world of hurt post-repeal, or roughly 524,000 altogether.

The ACA exchange in Arizona has had some pretty dramatic turns over the past month or so. When the dust settled, every county in the state will still have at least one carrier offering plans on the exchange...although only one. Anyway, today the AZ DOI joined Pennsylvania and Michigan in releasing their final approved rate hikes for both the individual and small group markets:

h/t to Bob Herman and Richard Mayhew for the tip:

OK, I admit that I first read this as Centene expanding into Pinal County (that's the one which came very close to not having any carriers on the exchange whatsoever, until Blue Cross Blue Shield agreed to stick around at the last minute). Unfortunately, no, Centene isn't going to offer plans there this fall. However, they are going to be participating on the ACA exchange in Maricopa and Pima Counties, which is still a very good development since Cigna and BCBS would otherwise have been the only exchange carriers in them respectively:

Centene Expands Marketplace Offering In Arizona

I don't know if this is an exclusive on the WSJ's Anna Wilde Mathews' part or not, but she's the first one I know of to break it:

Arizona’s Pinal County Gains Health-Law Exchange Insurer

Blue Cross Blue Shield of Arizona will offer plans on the Affordable Care Act exchange in Arizona’s Pinal County next year, resolving a situation that drew a national spotlight because it represented a major challenge to the mechanics of the health law.

When Aetna Inc. announced last month that it would withdraw from the exchange in Arizona, among other states, it left Pinal at risk of becoming the first U.S. county without a single insurer selling exchange plans. Aetna had been expected to sell exchange plans in Pinal County, where approximately 10,000 people had signed up for ACA plans.

When I last crunched the numbers for the 2017 individual market in Arizona, the average requested rate hike statewide was a whopping 68%. However, that was before Aetna dropped their bombshell about dropping out of the exchanges in 11 states (AZ included), leaving about 6,400 residents receiving ACA tax credits in Pinal County with no subsidized policy options whatsoever.

Since Aetna had intended on requesting a jaw-dropping 85.8% average rate hike if they had stuck around, this technically meant that the average requested hike for the other carriers would have dropped somewhat, although this would be limited by Aetna only having about 7% of the individual market in the state.

Over at the National Review, Michael "King v. Burwell" Cannon of the CATO Institute and self-described Obamacare-slayer has penned a piece which tears into the ACA over the situation in Pinal County, Arizona, where, barring a last-minute development, several thousand residents are about to find themselves in a pretty unpleasant situation when it comes to finding a new healthcare policy for 2017. As I noted last week:

Pinal County won’t have a company offering marketplace health insurance plans next year following the nation’s third-largest health insurer’s decision to exit public exchanges in all but four states.

Aetna was the only insurer planning to offer Affordable Care Act plans in Pinal County for 2017. It currently only sells in Maricopa County but had planned to expand to Pinal County.

Amidst my Aetna Postapalooza yesterday, there's one important point which other outlets have brought up which I haven't addressed yet: Pinal County, Arizona.

Since participation in the ACA exchanges has always been voluntary for carriers selling ACA-compliant individual policies (except for the District of Columbia (and until recently, Vermont), where carriers are legally required to only sell individual policies via the exchange), there's always been the danger that sooner or later there might be a situation where no carriers are selling on the exchange. Not "a few", not "only one"...zilch.

In my mind, I've always thought of this problem in statewide terms; it wasn't until 2015 that I even realized that many carriers only sell policies in some of the counties in a given state, not all of them. That makes the list of 300+ exchange carriers nationwide a bit misleading; some of the carriers listed for a given state might only be selling in a few or just a single county, making the scenario above far more likely to happen.

In yesterday's "all 50 state" wrap-up of my 2017 Requested Rate Hike analysis, among the numerous caveats/disclaimers was this one:

In some cases, estimates that I ran as recently as a few weeks ago may prove obsolete.

I was planning on revisiting some of the states I crunched numbers for back in May and June, but commenter "M E" beat me to the punch in Arizona, finding this Arizona Republic article from yesterday and, more importantly, the official AZ Dept. of Insurance Revised Rate Filing memo from August 3rd.

The article isn't pretty...

As of last week, five companies in Arizona had announced plans to pull out or pull back: Health Choice, United Healthcare, Humana, Blue Cross Blue Shield of Arizona and Health Net.

BREAKING Just Now:

CMS approves Arizona’s plan to re-open CHIP program

Today, the Centers for Medicare & Medicaid Services (CMS) announced that it has approved Arizona’s plan to allow new enrollment in the Children’s Health Insurance Program (CHIP) after enrollment was frozen for several years. Now all states provide CHIP coverage to eligible children. 

“Today’s approval is a step forward for the health of Arizona children in low-income families,” said Vikki Wachino, CMS Deputy Administrator and Director of the Center for Medicaid and CHIP Services. “With Arizona’s decision, all states in the nation now provide CHIP coverage to any eligible child who applies. More children in Arizona will have access to coverage early in their lives, which helps kids grow into healthy adults and provides parents with the peace of mind that comes from their children having affordable coverage.”

Having coverage through CHIP improves children’s health and increases their ability to succeed in school. Recent research on Medicaid and CHIP shows that these gains are long lasting, with children who gained coverage experiencing better health, higher educational attainment, and higher earnings as adults.

There are only 2 things I'm certain of when it comes to the requested rate hike filings in Arizona's individual market:

  1. It's a confusing mess.
  2. Regardless of #1, Arizona's requested rate hikes are jaw-dropping even when weighted by carrier.

The data below is drawn from two sources: The RateReview.HealthCare.Gov database and Arizona's Health Filing Access Interface (HFAI) SERFF database.

As you can see, there's some confusing and contradictory numbers, but I'll try to muddle through each:

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