Charles Gaba's blog

New York

The New York Dept. of Financial Services hasn't issued a formal press release yet, so it's conceivable that a few more filings will be added, but as far as I can tell, the spreadsheet below contains the preliminary unsubsidized 2023 premium change requests for every carrier offering ACA-compliant individual and small group market healthcare policies.

I've poked around the actual actuarial nattative summaries for several of the carriers with the higher market share (Excellus, Fidelis, etc) and while I see a couple of references to the set-to-expire expanded American Rescue Plan subsidies being set to expire at the end of 2022, this isn't listed as a significant factor in the rate filings (at least the ones I've looked at).

Assuming these rate hikes are approved of as is (which is no sure thing; New York tends to cut them down somewhat), unsubsidized individual market enrollees will be looking at average premium increases of 18.8%, while small group market policyholders will see a 16.3% average increase.

Florida

Throughout the 2 1/2 years of the pandemic, there have been numerous accusations of "cooking the books", "hiding deaths" and so forth thrown around at various administrations at the state and federal level. Some of these have proven to be false, others to be accurate, and many to be somewhere in between, depending on your perspective.

Perhaps no state-level administration has been subjected to as many accusations of "hiding data" as that of Florida Gov. Ron DeSantis. In my own case, the biggest data discrepancy I've written about regarding Florida was the massive vaccination rate outlier status of Miami-Dade County...a discrepancy which, at least in that case, turned out to be more about the legal residence of those vaccinated rather than whether the vaccinations actually took place or not.

That brings me to today's Florida COVID data update, courtesy of Ian Hodgson of the Tampa Bay Times:

 

It's particularly embarrassing for me to not have had this development on my radar seeing how I'm a life-long Michigander who also personally knows at least two of the state legislators onboard. Regardless, this is pretty exciting news from a healthcare policy wonk perspective:

The Michigan Legislature is considering joining the 18 other states that have established state-run health insurance marketplaces through HB 6112. Having an exchange run by the state instead of the federal government, supporters of the bill say, will save Michiganders money by leaving the “rigid and inflexible” federal market for a Michigan-tailored market that can be more responsive and potentially lower premiums. The bill is still in the early days of the legislative process, awaiting a vote from the House Health Policy Committee.

Sure enough, from last week:

COVID-19 Vaccine

Methodology reminders:

  • I go by county residents who have received the 2nd COVID-19 shot only (or 1st in the case of the J&J vaccine).
  • I base my percentages on the total population via the 2020 U.S. Census including all ages (i.e., it includes kids under 12).

Last September I wrote about something which had been bothering me for awhile:

HOWEVER, there's one major outlier over the 65% threshold...Miami-Dade County.

According to the Centers for Disease Control, Miami-Dade has fully vaccinated 68% of their entire population (1.84 million out of 2.72 million residents). I use the slightly lower official 2020 U.S. Census popualtion count for Miami-Dade County (2,701,767), which makes the vaccination rate slightly higher still: 68.24%.

And yet, somehow the 10th-largest county in the United States, which has the 6th highest vaccination rate of any county over 1 million residents, also has the highest new case rate of any county over 1 million residents.

At the time, it was Miami-Dade's massive outlier status in terms of COVID cases since the beginning of July which had tipped me off; it looked like this:

I haven't written about the ACA's Medical Loss Ratio (MLR) rule in awhile. I was pretty obsessed with it a few years ago, and I still check in on it from time to time, but otherwise I've mostly moved on to other things.

HOWEVER, the MLR rule is still pretty important...and while the dollar amounts I'm about to discuss aren't much more than a rounding error in terms of federal budget numbers, it's possible that the could play a small role in helping get a much larger project moving forward.

Before I begin, here's a short refresher on how the MLR rule works:

For over a year, I've been tracking the rates of both COVID-19 vaccinations as well as COVID-19 cases & deaths, broken out by county-level partisan lean (namely, what percent of the vote Donald Trump received in 2020).

I've received quite a bit of attention for these analyses, including several national media outlets which have used my work (sometimes with proper attribution, sometimes without) However, there have also been numerous critics who have pointed out that I don't run multivariate analysis when I do this.

Put simply, I look at the correlation between partisan lean and COVID death/vaccination rates or between vaccination rates and COVID death rates...but I don't include other factors like age, income, race/ethnicity, urban-rural status, employment status, health insurance status and so forth.

CMS Logo

via the Centers for Medicare & Medicaid Services:

  •  States will have an additional year to use American Rescue Plan funds to strengthen the home care workforce and expand access to services

 Today, the U.S. Department of Health and Human Services (HHS), through the Centers for Medicare & Medicaid Services (CMS), is notifying states that they now have an additional year — through March 31, 2025 — to use funding made available by the American Rescue Plan (ARP) to enhance, expand, and strengthen home- and community-based services (HCBS) for people with Medicaid who need long-term services and supports. This policy update marks the latest action by the Biden-Harris Administration to strengthen the health care workforce, help people receive care in the setting of their choice, and reduce unnecessary reliance on institutional care.

Regular readers may have noticed that I barely posted anything on the site last week, with good reason: I was out of town. I drove out to DC for a few days, ostensibly to attend the annual National Institute of Health Care Media (NIHCM) Awards Dinner, where I was a finalist in the Digital Media category this year.

(I didn't win, but that's OK...the competition was extremely impressive and it really was an honor just to be nominated, really!)

This was the fifth time I've visited the nation's capital, but the first time that I've driven. It's also the first road trip I've taken in an electric car, a brand-new 2022 Kia Niro EV (it replaced my 17-year-old Hyundai which was so badly rusted underneath that my mechanic was surprised it survived the past winter).

I don't often post blog entries about non-healthcare related issues, but I've had a lot of folks express curiosity about what it's like owning/driving an EV in the real world, so I figured this trip (which was, after all, for a healthcare awards dinner, and I also had healthcare policy meetings with a couple of folks on Capitol Hill) would be a good case study to give some thoughts on the subject.

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