(sigh) OK, I'm not sure if we've reached the 5th or 6th chapter in this ongoing saga, but I hope it's the last one.
When we last left our story (just 5 days ago), I noted that both the current number of enrollees as well as the average rate increases for each of the carriers on the Arkansas individual market had jumped all over the place at least 4 times, and that while it's common for these numbers to change a bit here and there throughout the multi-month filing process, both the degree of some of the changes as well as the circumstances surrounding them were often far beyond what I've typically seen in over a decade of tracking this stuff:
Given all the confusing numbers I've posted before, I've boiled it all down to the simplified tables below which illustrate the mess:
In the most recent chapter of the ongoing 2026 Arkansas rate filing saga, I noted that both the total number of residents enrolled in ACA individual market policies as well as the average 2026 rate increases for the six insurance carriers participating in the individual market next year kept changing, often in ways which were contradictory with other numbers claimed within the same press releases:
You'll notice that in addition to the rate changes being updated (increasing from a weighted average hike of 26.2% to 35.7%), most of the current enrollee figures were also modified, although these only changed slightly in most cases. Overall the total number of current individual market enrollees statewide dropped a bit from ~354,000 to ~345,000.
Minor changes like this aren't unusual; sometimes the carriers make slight tweaks as more recent data comes in or clerical errors are corrected; other times they round off the enrollee totals (that doesn't seem to be the case here, however).
Back in July I posted my analysis of the preliminary 2026 rate filings by the 6 Arkansas insurance carriers participating in the individual market. At the time, they looked like this:
I just finished writing up a deep dive into the Arkansas Insurance Dept's move from laissez faire-style Silver Loading to fully-regulated & maximized Premium Alignment in an attempt to mitigate the massive net premium damage about to be caused if the enhanced ACA premium tax credits expire at the end of 2025.
However, it's not just Arkansas which has finally seen the light and joined about a dozen other states in putting full-bore Premium Alignment (PA) pricing into place to help reduce the financial burden on ACA individual market enrollees in 2026.
Other states which have already done so in the past include Colorado (sort of), Texas, New Mexico, Maryland, Pennsylvania (somewhat), Illinois, Vermont and Wyoming.
Warning: This isn't just gonna get deeply wonky, it also requires digging deep into histroy. You've been warned.
Chapter 1: The (simplified) Backstory:
The ACA includes two types of financial subsidies: Advance Premium Tax Credits (APTC), which reduce monthly premiums; and Cost Sharing Reductions (CSR), which cut down on deductibles, co-pays & other out-of-pocket (OOP) expenses for low-income enrollees.
In 2014, then-Speaker of the House John Boehner filed a lawsuit on behalf of Congressional Republicans against the Obama Administration, in part because they claimed that CSR payments were unconstitutional because they weren't explicitly appropriated by Congress in the text of the Affordable Care Act.
A long legal process ensued, the end of which resulted in a federal judge ruling in the GOP's favor and ordering that CSR payments stop being made...but also staying that same order pending appeal of her decision by the Justice Department (then still run by the Obama Administration).
Over at Evensun Health, Wesley Sanders has written about two newbulletins from the Centers for Medicare & Medicaid Services (CMS) which, if followed to their conclusion, would cause massive changes to how ACA individual market policies are priced and marketed...along with dramatic changes to net premiums, deductibles, co-pays & other out of pocket expenses for exchange enrollees.
Warning: This one is not only absurdly wonky, it requires me to fire up the Wayback Machine and dig deep into the ACA's 15-year history. I actually wrote about this prospect back in January, but I haven't read or seen anything else about it since then...until today.
Today I want to address the question of Actuarial Value (AV)...that is, what percent of medical expenses (in aggregate) a given healthcare policy actually pays for. As a quick reminder, ACA policies are generally broken into four AV categories, labeled by metal levels: Bronze, Silver, Gold and Platinum, which generally cover roughly 60%, 70%, 80% or 90% of enrollees in-network medical expenses per year (there's a fifth category in front of Bronze called Catastrophic plans, but these have limited eligibility and hardly anyone enrolls in them anyway).
Note: I decided that while the original headline accurately reflected my feelings about this WSJ Op-Ed, it was a bit over the top, so I've changed it to something less crude.
For years, the Patient Protection & Affordable Care Act, generally shorthanded as the ACA or, more colloquially known as "Obamacare," was the top policy target of Republicans and other conservatives.
It seemed as though not a day went by without some right-wing opinion piece being published attacking the ACA for one thing or another. Once in awhile these attacks had some validity, but the vast majority were either completely baseless or grossly exaggerated.
And yet, after the dust settled on the infamous 2017 ACA "repeal/replace" debacle, it seemed as though the GOP had pretty much tired of their relentless assault on the healthcare law. They had failed to repeal it even with control of the White House, Senate, House of Representatives and Supreme Court, and ended up settling for zeroing out of the federal Individual Mandate Penalty as a consolation prize.
Thanks to the American Rescue Plan & Inflation Reduction Act, residents of every state + DC who earn less than 150% of the Federal Poverty Level (FPL), around $20,400/yr for a single adult, is eligible for a $0-premium "Secret Platinum" plan. If they earn between 150 - 200% FPL (roughly $27,200/yr), they're eligible for a slightly less-generous "Secret Platinum" plan with premiums less than 2% of their income (just $45/month for a single adult).
As I explained here, while Silver ACA plans normally only cover around 70% of the average enrollees' medical expenses (in aggregate), the ACA's "Cost Sharing Reduction" (CSR) subsidies mean that eligible enrollees who select "CSR Silver" plans will actually have 94% of their expenses covered for the < 150% crowd and 87% of their expenses covered for the 150 - 200% crowd.
Since Gold plans cover around 80% of expenses & Platinum plans cover roughly 90%, this means that "CSR Silver" is effectively "Secret Platinum" plans for anyone earning less than 200% FPL.
Advocates To CMS: Fix Rate Misalignment In Next Exchange Reg
A coalition of patient advocates is urging HHS to address high out-of-pocket costs by demanding that insurers selling marketplace coverage strictly adhere to the Affordable Care Act’s rate-setting requirements. Insurers have strayed from the mandate in recent years by underpricing silver-tier plans and overpricing the more-generous gold-level products, the advocates say, highlighting an issue that experts have been raising for years and that some states are already addressing at the local level.
But health experts also say that HHS must fix misalignments in the risk adjustment program - and that exchanges must have strong consumer decision support tools -for a policy fix to be sustainable.
By clarifying and enforcing the ACA’s single risk pool requirement, HHS could significantly reduce consumers’ cost-sharing burdens while also discouraging gaming, the advocates say.
