Pennsylvania

2018 MIDTERM ELECTION

Time: D H M S

This Just In from the Pennsylvania Insurance Dept...

Insurance Commissioner Highlights Minimal Rate Increases, More Consumer Choice in 2019 Health Insurance Rate Filings

Harrisburg, PA - Insurance Commissioner Jessica Altman today publicly released the 2019 requested rate filings for individual and small group health insurance plans under the Affordable Care Act, highlighting minimal rate increases and increased choices for many Pennsylvania consumers, including a new insurer in the individual market.

“Pennsylvanians want and deserve access to the comprehensive health coverage that the ACA provides. Enrollment over the past few years has remained steady, and this fall enrollees will have more choices, despite the Trump Administration’s relentless efforts to dismantle the ACA,” Gov. Tom Wolf said. “My administration is committed to ensuring that Pennsylvanians remain informed about their growing options and have access to quality, affordable health insurance.”

This is huge news given that Pennsylvania is the 5th largest state in the country (and a swing state to boot)...but it's also incredibly frustrating due what isn't included. From an official Pennsylvania Insurance Dept. Press Release:

Health Insurance Plan Rates Stabilize, Offer More Choice for Consumers Despite Federal Government Sabotage

Harrisburg, PA – Insurance Commissioner Jessica Altman today announced that health insurance rates in Pennsylvania have moderated significantly, counter to the national trend, after Wolf Administration efforts to combat the effects of sabotage on health insurance markets by the federal government and specifically the Trump Administration to dismantle the Affordable Care Act (ACA). Importantly, the filings indicate that rate increases in Pennsylvania will be significantly more modest in 2019 than other states and many consumers will see more choices in their local markets as a result of Pennsylvania's efforts to increase competition.

As you may have noticed, I'm on a bit of a grandfathered/transitional plan data kick this week (there's a reason for it which you'll understand next week). These numbers are tricky to hunt down, since they aren't tracked by the ACA exchanges. Most states either don't track them at all or don't make it easy for the public to locate, and it's even treated as a proprietary trade secret in a few states.

The Kaiser Family Foundation gave a rough estimate of around 2.1 million people still being enrolled in GF/TR plans last year, but they never broke it out by state. Plus, of course, that was last summer; since no one can newly enter these types of policies, their numbers continue to gradually shrink year after year.

 

OK, it's been a lonnnnnnng week (and it's only Tuesday!), so it's time for something a little different...

U.S. Rep Pat Meehan said Tuesday he had developed a deep “affection” for a younger aide and told her that he saw her as “a soul mate” as they talked over ice cream one night last year, but in an interview with the Inquirer he said he never pursued a romantic relationship with the woman, who later accused him of sexual harassment.

Meehan, a Delaware County Republican, also acknowledged that he initially reacted “selfishly” when he found out the aide, decades younger than him, had entered into a serious relationship with another man, and shared a heartfelt, hand-written letter he wrote to her in May wishing her well, but also thanking God “for putting you into my life and for all that we have seen and experienced and genuinely shared together.”

He also said he intends to continue running for reelection in Pennsylvania’s Seventh District.

With the big news this week about CMS giving work requirements the green light and Kentucky immediately jumping all over it, I decided to look up a few data points from some expansion states which don't include a work requirement for the heck of it:

MICHIGAN:

  • As of January 8th, 2018, Michigan had 669,362 adults enrolled in the "Healthy Michigan" program (aka, ACA Medicaid expansion), or over 6.7% of the total population.
  • Men make up slightly more enrollees than women (51% to 49%)
  • Enrollees are spread fairly evenly by age brackets (19-24, 25-34, 35-44, 45-54 and 55-64)
  • Around 80% of MI expansion enrollees earn less than 100% of the federal poverty line; the other 20% earn between 100-138% FPL.

LOUISIANA:

  • As of January 8th, 2018, Louisiana had 457,178 adults enrolled in Medicaid expansion (nearly 9.8% of the population)
  • Women make up 62% of enrollees

As of December 4, 2017...

Pennsylvania is the first state which has released their approved 2018 rate hikes since Donald Trump officially pulled the plug on CSR reimbursement payments last Friday. It's also one of just 16 states which had yet to do by then. Most of the remaining states are small or mid-sized, so plugging Pennsylvania into the 2018 Rate Hike Project leaves just Texas, North Carolina and New Jersey as missing states with more than 8 million residents.

Back in June, the PA Insurance Commissioner was pretty up front and clear about what the major causes of 2018 rate increases on the individual market would be:

Insurance Commissioner Announces Single-Digit Aggregate 2018 Individual and Small Group Market Rate Requests, Confirming Move Toward Stability Unless Congress or the Trump Administration Act to Disrupt Individual Market

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)...

Pennsylvania is way too easy for me this year; I don't even have to plug numbers into a spreadsheet to figure out the statewide average rate hikes.

Why? Because the state insurance commissioner has already done the math for me...and then some:

Insurance Commissioner Announces Single-Digit Aggregate 2018 Individual and Small Group Market Rate Requests, Confirming Move Toward Stability Unless Congress or the Trump Administration Act to Disrupt Individual Market

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). By the end of March, the numbers in these 4 states had gone up by another 19,300.

It's the end of April now, so I checked in once more, and sure enough, the numbers continue to grow:

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

Back on February 28th I noted that ACA Medicaid expansion enrollment across three states (Michigan, Louisiana and Pennsylvania) had grown by about 35,000 people since mid-January, to 667K, 406K and 716K people respectively.

Today, a month later, I decided to take another look at all three states, along with Minnesota (which I forgot to check last month). Sure enough, enrollment has continued to grow in all four, albeit at a slower pace:

Over the past month or so, I've been tallying up the number of people who would lose their healthcare coverage if and when the GOP actually does proceed with repealing the Affordable Care Act, breaking the totals out by both County and Congressional District in every state.

While this project has received high praise as a useful resource, one problem with it is that the numbers aren't static--between the high churn rate of the individual market and Medicaid, as well as the fact there's no limited enrollment period for Medicaid (you can sign up year-round), the enrollment figures are constantly changing.

Case in point: As of January 20th,, roughly 706.000 Pennsylvanians were enrolled in ACA Medicaid expansion. As of February 17th that number had increased to over 716,000.

I don't have a county-level breakout of the updated number, but I'm assuming that each county/congressional district has increased roughly proportionately:

I haven't posted an update on Pennsylvania's implementation of the ACA's Medicaid Expansion provision since last May, when it stood at around 625,000 enrollees.

Just moments ago, PA Governor Tom Wolf announced that enrollment has now broken the 700,000 milestone:

Over 700,000 Additional Pennsylvanians Enrolled in Governor Wolf’s Medicaid Expansion Plan
February 02, 2017

Harrisburg, PA – In February of 2015, Governor Wolf expanded Medicaid to ensure that Pennsylvanians can receive affordable, straightforward, accessible healthcare without unnecessary delays and confusion. Today, Governor Wolf announced that over 700,000 Pennsylvanians have enrolled in HealthChoices, Pennsylvania’s mandatory managed care Medicaid program, since expansion occurred two years ago. U.S. Census data shows that the commonwealth’s uninsured rate has dropped from 10.2 percent in 2010 to 6.4 percent in 2015.

Hey, remember back in August 2016 when Aetna, just three months after saying how great things were going for them on the ACA exchanges (to the point that they might even expand into several additional states), did a complete 180º by announcing that they were instead going to leave 11 of the 15 states they had been participating in?

At the time, it seemed awfully suspicious; as I noted on 8/15/16:

Oh. Well, I'm sure that was just a sheer coincidence, right? No doubt Aetna will clear this up with an unequivocal statement to put any speculation to...

From Peter Sullivan of The Hill:

Asked if the DOJ’s actions on the merger had any relation to Monday’s announcement, Aetna spokesman TJ Crawford did not directly say yes or no.

(thanks to commenters "M E" and "joe" for the heads up).

The state Dept. of Insurance has released their approved rate hikes for 2017, and it's bad news in two different ways. First, the overall full-price average rate increase looks like it'll be roughly 32.5%...over 8 points higher than the original rates requested by the carriers. Secondly, even with those higher increases, two more indy market carriers (Keystone Health Plan and Geisinger Quality Options) are pulling off the exchange, although both will continue to offer off-exchange plans.

It's important to be careful with the full carrier names here, because they often operate under several different very similar ones (Keystone Health Plans vs. Keystone Health Plan East, for instance, which is not pulling off the exchange).

So here's what's happening with each:

Yesterday I hobbled together the weighted average rate hikes (either requested or approved) for the ACA-compliant small group markets across 15 states. In 4 of these states, I hadn't yet tallied the weighted average, so I temporarily used the median increase for each. In the case of Pennsylvania, the range was from a 3.8% decrease to a 33% increase, with a midpoint of around 14.6%.

Today, however, I've actually plugged in the enrollment numbers for each sm. group carrier in Pennsylvania based on their 2017 rate request filings, and have come up with a weighted average of just 7.9%:

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