Charles Gaba's blog

Standard & Poor's, December 22, 2016:

Well THAT figures: Insurance carriers finally breaking even on ACA exchanges just in time for GOP to tear up the law.

Health insurers may finally be seeing improved results on their Obamacare plans just as a newly elected president is poised to follow through on promises to end the controversial coverage program, a new report suggests.

An analysis out Thursday says that health insurers are expected in 2016 "to start reversing" financial losses on their Obamacare business after "hitting bottom" in 2015.

And 2017 "will likely see continued improvement" for those insurers selling individual health plans, "with more insurers getting close to breakeven or better," according to the report by Standard and Poor's Global Ratings.

Last year Virginia was the first state out of the gate with their initial 2017 individual & small group market rate filings. I'm not sure if this is chance or if they simply have the earliest filing deadline. I'm guessing the latter, because, as Zach Tracer noted earlier today, Virginia is again the first state to list their 2018 Individual and Small Group Market participants. Remember, these are initial filings only, and very much subject to change throughout the summer and early fall. Here's who Tracer says has stated is committing to being on the ACA exchanges this fall...at the moment, anyway:

 

UPDATE: ...or, perhaps not. Latest word is that there's basically little to see here; lots of big talk about pushing forward but very little action. Or perhaps there will be next week, who the heck knows? Wash, rinse, repeat.

On March 24th, just after the AHCA (Trumpcare) bill was yanked from the House floor with literally minutes to go, I posted the following headline:

CELEBRATE A FEW HOURS. Then come back and read this.

Well, according to Matt Fuller and Jonathan Cohn of the Huffington Post, Trumpcare 2: Electric Boogaloo may indeed be a go:

As far as I can tell, even the amazing Louise Norris hasn't caught this one yet (and it's a month old, too!). If I'm wrong and she has done a write-up on it, of course, I'll eat my words:

Medicaid for all

Democratic [Nevada] Assemblyman Mike Sprinkle has introduced a bill, AB374, to open up the state’s Medicaid program to anyone, regardless of their income level.

Individuals would be able to purchase coverage through Medicaid on the healthcare exchange for an annual premium set at 150 percent of the median expenditure paid on behalf of Medicaid enrollees in the preceding fiscal year. Though none of the current federal or state dollars going to fund Medicaid would be used to cover any portion of the new enrollees, they would still be entitled to the same benefits provided to other Medicaid recipients.

 

Watch the 4-minute clip above and weep.

If you can't hear it, here's the transcript of California Democratic U.S. Senator Diane Feinstein's response when asked how (not if, mind you...how) she would support moving to a Single Payer healthcare system:

She starts out by making an incredibly tone-deaf and inaccurate statement about single payer:

"If by ‘single payer’ you mean that it’s going to be a complete takeover by the government, of healthcare, then I am not there.

As most people know by now (well, most people in Tennessee, anyway), Humana decided a full two months ago to bail on the entire individual market, across the board--every state, both on and off the exchange, the works. This stung in quite a few counties across 11 different states, but the one which everyone is freaking out about is Tennessee...because there are 16 counties where Humana was the only carrier participating on the ACA exchange. Here's the list of Tennessee counties Humana is available in this year; note that there's an additional 14 counties where there's one other carrier available at the moment.

While I've been embroiled in the sturm und drang at the national level, Louise Norris of healthinsurance.org has been reporting on some important stuff happening at the state level:

HAWAII:

Hawaii no longer has a SHOP exchange; Lawmakers consider bill to preserve the ACA and expand Medicaid to 250% FPL

As of 2017, Hawaii no longer has a SHOP exchange for small businesses. The State Department of Labor and Industrial Relations has an FAQ page about this.

...Hawaii’s waiver aligns the ACA with the state’s existing Prepaid Health Care Act. Under the Prepaid Healthcare Act, employees who work at least 20 hours a week have to be offered employer-sponsored health insurance, and can’t be asked to pay more than 1.5 percent of their wages for employee-only coverage (as opposed to 9.69 percent under the ACA in 2017). 

 

Exactly one month ago, I asked a rhetorical question:

How High will Initial 2018 Rate Hike Filings Be?

...and then went on to conclude that, given the insane amount of uncertainty and confusion about what Donald Trump, Tom Price and the Congressional GOP in general has in mind for the 2018 insurance market, on top of normal stuff like inflation, an aging population and so on, that there are five likely scenarios:

Now, put yourself in the position of an insurance carrier executive and/or one of their actuaries. The level of uncertainty in the air is mind boggling. You have five choices for your initial filing:

 

Tom Cotton at townhall: still supports repealing ACA but commits to protecting coverage for 300k Arkansans dependent on Medicaid expansion.

— David Ramsey (@ArkDavey) April 17, 2017

(says this is key reason he opposed AHCA, which would have eliminated the Medicaid expansion altogether)

— David Ramsey (@ArkDavey) April 17, 2017

Just so we're clear here:

Well, HHS Secretary Tom Price and CMS Administrator Seema Verma have released the final, official rules for the 2018 Open Enrollment Period. For the most part they're exactly what was originally proposed a couple of months ago, but it's worth reviewing again now that the changes appear to be final. Here's the main ones:

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