I ran the numbers for Illinois' requested 2019 ACA individual market rate changes back in August. At the time, the weighted year-over-year average was a mere 0.7% increase, with Cigna and Health Alliance's 10% and 7.5% being mostly cancelled out by Celtic's 1.1% and especially Blue Cross Blue Shield's slight drop of 0.9%. Since BCBSIL holds something like 3/4 of the state's individual market share, that alone mostly wiped out the other increases.
Unfortunately, I don't have access to the hard enrollment numbers, so this was a rough estimate based on 2017's breakout. Here's what it looked like at the time:
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%:
With the 2019 Open Enrollment Period quickly approaching, I'm spending a lot of time swapping out the requested carrier rate changes from earlier this summer with the approved rate changes from state regulators.
Hawaii only has two carriers participating in the ACA-compliant individual market: HMSA and Kaiser, which requested rate increases of 2.72% and 28.6% respectively back in August. With a roughly 57/42 market share split, this resulted in a weighted average rate increase of 13.8%, which would likely have been closer to 3.8% if the ACA's individual mandate penalty hadn't been repealed.
With just 3 weeks to go before the 2019 Open Enrollment Period begins, the dust has mostly settled on my 2019 Rate Hike Project. Over half the states have provided their final, approved individual market premium changes, and while I haven't found the final rates for the other half yet, their preliminary rates are all on record, so I don't anticipate the needle moving too much at this point.
New Hampshire is among the states which I haven't found final rate changes for yet. The three carriers in the state have requested average price reductions of around 13.5% on average, which is well below the 3.2% increase which is the average nationally, but I still don't know what the state regulators are going to approve.
This makes the following press release rather surprising:
NH Insurance Department to Hold Oct. 30 Annual Public Hearing on Health Insurance Premiums
When I last posted about 2019 ACA-compliant individual market premium changes in Tennessee back in August, I noted that premiums statewide had gone from dropping 5.7% to dropping 10.8% on average after the Trump Administration first stated that they were going to unnecessarily "freeze" the ACA's Risk Adjustment fund transfers in response to a lawsuit ruling only to reverse themselves a week or so later and state that they were going to go ahead and process RA fund transfers after all.
In other words, the Trump Administration once again deliberately caused a panic across the industry only to "save" the industry from the very threat which they had posed in the first place.
In any event, here's what I thought the Tennessee's premium situation looked like when the dust settled:
Back in August, Blue Cross Blue Shield of South Carolina, the only carrier offering policies on SC's individual insurance market, asked for a 9.2% average premium rate increase for 2019 statewide. This consisted of 9.3% for their most popular plans (which cover over 200,000 South Carolinans) and 6.9% for 6,800 BlueChoice plan enrollees (BlueChoice is only available off-exchange).
Most Connect for Health Colorado® Customers Will See Decrease in Premiums for 2019 as Marketplace Stabilizes
DENVER — With rate increases lower than the state has seen in years, Connect for Health Colorado® customers who qualify for financial help are looking at an average decrease in their net (after tax credit) premium of 24 percent next year.
The Colorado Division of Insurance today issued final approval for individual health insurance plans that will increase by an average of 5.6% in 2019. The relatively small increase in monthly premiums and the return of all seven health insurance companies to the Connect for Health Colorado, the state’s health insurance Marketplace, are signs of a stabilizing market for Coloradans who buy their own health insurance coverage.
I just received the following press release from the Iowa Insurance Division...
2019 Health Insurance Enrollment Deadline Approaches
Des Moines – Open enrollment begins November 1 and ends December 15 for Iowans purchasing or changing their Affordable Care Act (ACA) individual health coverage to become effective January 1, 2019.
“As the open enrollment season begins, Iowans should thoroughly research all coverage options. The ACA-compliant insurance market is available to Iowans, however, most Iowans have been priced out of that market if they are not currently receiving federal subsidies to help pay premiums and, in some instances, deductibles. I would encourage consumers to meet with a licensed insurance agent to determine the best plan for themselves and their families,” Iowa Insurance Commissioner Doug Ommen said. “Changes made at the Iowa state legislature and by the federal government have provided a few more options in addition to ACA-compliant coverage for Iowans to review as they plan out their health needs for 2019.”
Minnesota, currently entering their second year of their official reinsurance waiver program to help keep unsubsidized premiums down, announced their preliminary 2019 rate hikes way back in June. At the time, the carriers were looking at roughly an 8% average reduction in rates next year...although they would be dropping prices by more like 15% if not for the ACA's individual mandate being repealed and the expansion of #ShortAssPlans.
Today the Minnesota Dept. of Commerce posted the approved 2019 premium changes, and there's been some dramatic reductionsfor three of the five carriers offering policies in the state. Group Health and Medica were approved as is, but Blue Plus was told to drop their rates a whopping 27.7% instead of the 11.8% they were planning on. Ucare was shaved down from a 7 point reduction to 10 points, and PreferredOne (which only sells individual market policies off-exchange and only has 300 enrollees anyway) was knocked down from a 3-point reduction to 11 points.
The official annual ACA Open Enrollment Period (OEP) starting and ending dates have jumped around a lot since the exchanges kicked off back on October 1, 2013.
For the first OEP, people were given 6 months since the technology and the process were brand new to everyone...and thank God they were given the technical mess that the federal exchange (HealthCare.Gov) as well as many of the state-based exchanges experienced at launch. Things were eventually worked out, but not only was that extra time in spring 2014 vitally important, many people still needed some extra time beyond that as well. The official deadline to enroll for 2014 coverage was March 31, but the HHS Dept. gave people who had started their application by then an extra 15-day "overtime" period to complete the process.
For the 2015 OEP, the official dates were from November 15 - February 15th, cutting the time period down to three months. This time there was a one-week "overtime" period tacked onto the end.
For 2016 and 2017, HHS settled on November 1st - January 31st, which seemed to make sense since it was easier to remember: November, December, January.
I ran the numbers for Nevada's preliminary 2019 ACA individual market rate changes back in July. At the time, the average requested rate increase was around 2.3% statewide.
With the 2019 Open Enrollment Period coming up fast, I checked on the approved rate changes and found that state regulators had cut down on the rates quite a bit...although mostly for carriers which only offer off-exchange plans and only have small numbers of enrollees anyway.
For instance, HMO Colorado (dba HMO Nevada) originally requested a 20.9% increase; this was reduced to 9.5%...but they only have 200 people enrolled anyway, so it's not even a rounding error. Rocky Mountain was cut from 34.4% to 18.5%...but only has 300 enrollees, and so on.
The three carriers which hold the vast bulk of the market had far less dramatic changes, although Silver Summit was cut from a 5.2% increase to a 1.1% decrease for 2019.
eHealth Insurance is a leading private online health insurance exchange, and is licensed to sell health insurance in all 50 states and the District of Columbia. They also publicly post survey results of both their membership and insurance carriers from time to time. While eHealth isn't necessarily fully representative of the entire individual health insurance market, the fact that they cover every state +DC means their surveys should provide at least some big picture insight into the landscape.
(For those wondering: No, this is not an endorsement, they aren't paying me to promote them, and I haven't a clue whether or not they're a good or bad company to do business with.)
As I noted last month when I first analyzed the requested 2019 rates for North Dakota insurers, ND was somewhat unique last year in that it was one of only two states (the other was Vermont) which didn't tack on any extra premium increases for 2018 to account for the lost Cost Sharing Reduction reimbursement revenue after Donald Trump cut off those payments last October.
This led to one of North Dakota's three carriers, Medica, dropping off the ACA exchange altogether, though they still ended up enrolling a few hundred people directly via the off-exchange market.
As I noted back in July, in addition to the Trump Administration's Centers for Medicare & Medicaid (CMS) chopping down the marketing budget for HealthCare.Gov by 90% last year, they also slashed the navigator/personal outreach budget by over 40% as well, from $63 million down to $36 million...and this year have cut it by another $26 million, to just $10 million across all 34 states which rely on HealthCare.Gov to host their ACA exchange open enrollment functionality (there are 5 more states which are hosted by HC.gov, but which I believe operate their own exchange and navigator budget: Oregon, New Mexico, Nevada, Kentucky and Arkansas). Combined, that makes an 84% reduction in navigator funding over a 2 year period.
Open enrollment for 2019 coverage will begin October 15, 2018 in California, and continue until January 15, 2019
Nationwide, open enrollment for 2019 coverage is scheduled to run from November 1, 2018 to December 15, 2018 — the same schedule that was followed in late 2017 for 2018 coverage. But Covered California was one of only three state-run exchanges that opted in 2017 to keep open enrollment at three months in duration for 2018 coverage (the others were New York and DC).
And the state enacted legislation (A.B.156) in late 2017 that codifies a three-month open enrollment period going forward — California will not be switching to the November 1 – December 15 open enrollment window that other states will be using.