START OF 2018 OPEN ENROLLMENT PERIOD

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South Dakota

Protect Our Care is a healthcare advocacy coalition created last December to help fight back against the GOP's attempts to repeal, sabotage and otherwise undermine the Affordable Care Act. This morning they released a report which compiled the approved 2018 individual market rate increases across over two dozen states.

Needless to say, they found that the vast majority of the state insurance regulators and/or carriers themselves are pinning a large chunk (and in some cases, nearly all) of the rate hikes for next year specifically on Trump administration sabotage efforts...primarily uncertainty over CSR payment reimbursements and, to a lesser extent, uncertainty over enforcement of the individual mandate penalty.

South Dakota is another fairly straightforward state: Two carriers, around 31,000 total ACA-compliant enrollees on & off exchange. Neither filing indicates whether they're assuming CSR payments will be made or not, so I'm assuming they're based on them being paid.

As I noted when I crunched the numbers for Texas, it's actually easier to figure out how many people would lose coverage if the ACA is repealed in non-expansion states because you can't rip away healthcare coverage from someone who you never provided it to in the first place.

My standard methodology applies:

He hasn't even been sworn in yet:

A proposal to expand a federal health insurance program for needy people could be off the table following the results of Tuesday's election.

The victory of Republican Donald Trump, who has called for a repeal of Obamacare, along with the increasingly conservative Republican make-up of the South Dakota state Legislature could thwart Gov. Dennis Daugaard's efforts to expand Medicaid in the state.

Daugaard for more than a year has worked with the Obama administration and the Indian Health Service to strike a deal, which stemmed the approval of a federal policy that allows the state to spend less on Medicaid-eligible Native Americans. And part of that bargain has been staked on South Dakota using the savings to cover an additional 50,000 South Dakotans under Medicaid.

Trump hasn't set a clear policy position on Medicaid expansion but has said he'd repeal the Affordable Care Act, though two of his closest allies, New Jersey Gov. Chris Christie and Indiana Gov. Mike Pence, have accepted Medicaid expansion.

Normally I post screenshots from the revised/updated SERFF filings and/or updates at RateReview.HealthCare.Gov, but it takes forever and I think I've more than established my credibility on this sort of thing, so forgive me for not doing so here. Besides, #OE4 is approaching so rapidly now that this entire project will become moot soon enough, as people start actually shopping around and finding out just what their premium changes will be for 2017.

The other reason I'm not too concerned about documenting the latest batch of updates/additional data is because in the end none of it is making much of a difference to the larger national average anyway; no matter how the individual carrier rates jump around in various states, the overall, national weighted average still seems to hover right around the 25% level.

Still, for the record, here's the latest...in four states (Iowa, Indiana, Maine & Tennessee) I've just updated the requested and/or approved average increases. In the other four (Massachusetts, Montana, North & South Dakota) I've added the approved rate hikes as well.

Thanks to commenter "InTheKnow" for the heads up:

Wellmark Blue Cross and Blue Shield announced Tuesday that it will narrow its choices for individual Affordable Care Act plans in Iowa and will eliminate ACA individual plans in South Dakota altogether in 2017.

First, some clarification: Wellmark isn't on the exchange to begin with, and wasn't planning on joining it in SD next year, so this is a rare case of a carrier dropping their off-exchange individual market offerings. Since all of Wellmark's indy enrollees in South Dakota are paying full price, this one can't be blamed on APTC enrollees being sicker than average, etc.

Having said that, this does impact around 8,000 off-exchange enrollees in SD.

As for Iowa, it's more of a mixed bag...Wellmark is basically swapping out higher end PPO plans for lower end HMO, which is pretty much the trend everywhere:

Last month I noted that while South Dakota hadn't posted their ACA-compliant 2017 rate filings yet, they had posted their grandfathered/transitional filings, and decided to take a look at those. While GF/TR plans are down to a pretty nominal number in most states (and about half the states don't have any transitionals at all at this point), SD still has a huge portion of their individual market enrolled in them (over 1/3, from what I can tell).

Only 4 carriers appear to be participating in the ACA-compliant individual market in South Dakota next year: Aetna, Sanfrod, SD State Medical and Welmark. I only have the enrollment numbers for 3 of the 4, but the requested rate hike for the fourth one (Sanford) is pretty close to the average of the other three anyway, so it shouldn't really impact the overall average by much:

It's been nearly 2 weeks since the last update to my 2017 Requested Rate Hike project. While I've locked down the requested increases for 35 states and the District of Columbia, the remaining 15 states seem to be pretty quiet about their 2017 rate filings. Today, however, I'm able to fill in at least half of the puzzle for one state: South Dakota.

To the best of my knowledge, there are only 6 carriers offering policies on the SD indy market: Avera, DakotaCare (off-exchange only), Sanford, SD State Medical, Celtic and Wellmark BCBS. It's worth noting that DakotaCare is in the process of being bought out by Avera, but I'm not sure whether they'll be submitting separate filings or not.

SD's total individual market was roughly 73,000 people in 2014, and has presumably grown since then to perhaps 90,000 today...including grandfathered and transitional enrollees.

Not much to add here:

A special session for Medicaid expansion will have to wait, Gov. Dennis Daugaard announced Wednesday.

After a weeks-long effort to lobby enough lawmakers to get the proposal approved in the Statehouse, Daugaard announced in a statement that he wouldn't call lawmakers back to Pierre.

Citing the upcoming presidential election that could result in substantial changes to the federal health insurance program for needy people, Daugaard said a special session was off the table.

“We have a good plan that would increase health care access at no additional state cost and guarantee that the federal government won’t shift its responsibility to pay for Native American health care to the state,” Daugaard said in a statement. “Still, I have heard from legislators that they would like more time to study this plan and in particular want to wait to consider the issue until after the presidential election. For that reason, I will not be calling a special session to take up this issue.”

Unlike the exchange QHP enrollments, which will always continue to be the heart and soul of this website (it's right there in the name, after all), I've kind of gotten away from trying to track Medicaid expansion on a granular level over the past few months. The main reason for this is that in many of the expansion states, they've simply maxed out on enrollees, and the numbers from week to week or even month to month are simply holding steady at this point.

With South Dakota's DAKOTACARE dropping off the ACA exchange and asking for 63% rate hikes, this (potential) development can't come soon enough:

South Dakota may join 30 other states in expanding its Medicaid program if federal officials approve a plan Gov. Dennis Daugaard is set to outline to the nation’s top health and human services administrator in Washington on Tuesday.

The Republican governor is meeting with Health and Human Services Secretary Sylvia Burwell to explain the plan, and the federal government has so far been more open to discussions than in the past, said Tony Venhuizen, chief of staff to Daugaard. The proposal, which is in its early stages, would make about 48,500 South Dakota residents newly eligible for the program.

The twist this time is that the Indian Health Service, which provides healthcare coverage for around 2 million Native Americans nationally, would be involved:

A few weeks ago, I crunched the (minimal) enrollment/rate numbers for South Dakota and came up with a fairly ugly weighted average rate hike of 27.4% (ouch). Being such a small state & population, there are only 5 insurance companies total offering individual policies either or off the exchange: Avera, Sanford, Welmark, Celtic and SD State Medical Holding, otherwise known as "DAKOTACARE" for some reason (and no, I refuse to capitalize the whole thing in the headline).

This evening Louise Norris informed me that DAKOTACARE has made 2 rather startling changes of plan: First, they're dropping off of the ACA exchange and will only be selling policies off-exchange...and instead of their previously-requested 18-20% rate hike, they've suddenly decided that they have to jack up rates an eyebrow-raising 63% next year.

This is a perfect follow-up to my last story about the new Agile Insurance report.

According to their report, "100%" of South Dakota's individual insurance market products have requested double-digit rate hikes next year, which sounds bad.

However, also according to their report, "0%" of those products are seeking hikes higher than 20%.

According to Agile Health Insurance, in other words, every single South Dakota insurance plan sold on Healthcare.Gov is seeking somewhere between 10-20% hikes, right?

OK...but look what happens when you include the off-exchange "products" as well:

How the hell did that happen?

In an election where people like me are practically begging Democratic candidates in blue states to campaign on the Affordable Care Act, this is a jaw-dropping development.

South Dakota's Senate race normally would be considered a yawner. While the state does have a history of electing the moderate Democrats from time to time, it's pretty red for the most part, and no one was expecting Democrat Rick Weiland to have much of a chance against former Republican Governor Mike Rounds.

However, in an interesting development, independent candidate Larry Pressler has jumped into 2nd place in a recent poll. The thing is, Pressler isn't some no-name small timer; he's already a former U.S. Senator, serving for 3 terms before losing to Democrat Tim Johnson in 1996.

With Johnson retiring, his seat is open, and Pressler wants it back, so he's jumped back into the game. Here's the thing, though: Pressler used to be a Republican. In South Dakota.

My in box is once again flooded with ACA-related stories which are interesting but which I just don't have time to do full write-ups on...

ILLINOIS: Clock Ticking For Illinois To Form State-Run Obamacare Exchange

Unless Illinois acts quickly, it will leave hundreds of millions of federal dollars on the table that would go toward building its own health insurance marketplace, potentially upping the cost of coverage for nearly 170,000 Illinois residents. State lawmakers, unable to break a years-long standoff, have not passed a law authorizing a state-based exchange, the marketplaces created under the Affordable Care Act that allow consumers to compare and buy health coverage, often with the help of federal tax credits. As a result, Illinois was one of 36 states that relied on the federal government to host its marketplace on HealthCare.gov, the website that survived a disastrous launch late last year to enroll about 217,000 Illinoisans, 77 percent of whom received federal help.

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