Earlier this year, in response to popular demand, I put together an extensive list of serious proposals to actually repair, improve and strengthen the ACA itself, as opposed to a) tearing it apart and replacing it with the GOP's Godawful pile of crap or b) tearing it apart and attempting to replace it with a total single payer system (which simply is not going to happen in the near future no matter what).
I came up with some of these ideas on my own (though I'm sure others have made similar suggestions), but most of them have been widely discussed by various heatlhcare wonks over the past few years. Some would require additional funding, but others are simply regulatory and wouldn't cost a single state or federal dime.
One of these seems to be catching on pretty quickly...number 12:
12. LEGALLY TIE MEDICARE ADVANTAGE/MANAGED MEDICAID CONTRACTS TO EXCHANGE PARTICIPATION.
OLYMPIA, Wash. - Eleven health insurers filed 71 health plans for Washington state’s 2018 individual and family health insurance market, with an average proposed rate increase of 22.3 percent. No health insurer filed plans in two counties – Klickitat and Grays Harbor.
Insurance Commissioner Mike Kreidler has been reaching out to insurers since they filed their plans on June 7 to see if one or more will reconsider offering plans in the bare counties.
“I’m very concerned by the proposed changes we’re seeing,” Kreidler said. “I know these numbers will be extremely upsetting to people who buy their own health insurance. They’re upsetting to me. We’re going to spend the next several months reviewing every assumption insurers have made to make sure their proposed increases are justified.
Last week I analyzed the monthly enrollment effectuation numbers through all 4 years of ACA Open Enrollment (2013 - 2017), to help visualize how the enrollment numbers flow throughout the year (and to also show how misleading the Trump CMS "attrition" report from last week was).
Then, on Thursday, I wrote about a CMS powerpoint presentation from last year which provided a Holy Grail of sorts for me: Not only did it provide the monthly effectuation numbers for 2015, it broke them out by starting and ending month. That is, it divided the numbers into how many enrollees for that month had originally enrolled starting in January, in February and so forth. This is really, really important because having "an average" of 100,000 enrollees each month doesn't mean much if it's a different 100,000 people every month--that is, if a lot of people are signing up, having expensive treatments and then dropping out and then replaced by someone else, that hurts the risk pool, since the original batch aren't paying for the other months of the year when they don't require treatment.
As regular readers know, I've been a bit obsessive about tracking down and breaking out ACA Medicaid expansion enrollee numbers. This is more difficult than it sounds, because most Medicaid reports lump expansion enrollees in with the other ~58 million or so Medicaid enrollees; only a handful of states issue separate reports of the expansion-specific population on a regular basis.
Back in late November, I cobbled together the data as best as I could and came up with a total of roughly 11.3 million people nationally. However, that included a lot of 2-year old data and rough estimates.
A couple of weeks later, I stumbled upon a detailed analysis from an anti-ACA financial watchdog organization, the Foundation for Government Accountability, which provided hard numbers and confirmable data source links which included more recent numbers for many states. This brought the total up to over 12.3 million.
Health insurer Centene Corp. plans a broad expansion of its Obamacare offerings next year at a time when many of its big rivals are retreating from the program.
Centene said Tuesday that it would sell Affordable Care Act plans in three additional states: Kansas, Missouri and Nevada. The company also said it will expand in six states where it already offers Obamacare plans.
“Centene recognizes there is uncertainty of new health-care legislation, but we are well positioned to continue providing accessible, high quality and culturally-sensitive health-care services,” Chief Executive Officer Michael Neidorff said in the statement.
The company specializes in providing Medicaid coverage for low-income people, and has said the skills it’s honed in that business have helped make it successful in Obamacare markets.
Two market influences, in particular, are complicating 2018 rate setting: the uncertainty surrounding continued funding of cost sharing reduction (CSR) payments and the question of how the relaxation of the individual mandate will impact enrollment and risk pools.
Earlier this week I busted the Trump Administration's CMS division for releasing a misleading report which tried to understate the enrollment retention rate of ACA exchange enrollees. I'm not entirely sure why they did this, since even their "fudged" number wasn't really that much worse than previous years (they tried to make itt look like a March attrition rate of 15.4% vs. the 12.8% and 12.6% from 2015 and 2016 respectively), but for whatever reason, they did so. The short version is that they only included enrollees who paid for their January and February policies instead of also including those who paid their March premiums, as was done in previous years. As far as I can figure, the actual 3/31/17 effectuation rate closer to 11.8%, a slight improvement over 2015 and 2016, though I can't be certain about this without knowing how many of the ~500,000 people who signed up in the last 2 weeks of January paid and were effectuated for March coverage.
Calculating the average requested rate hike in Delaware is easier than most states. This year they officially have 5 carriers participating in the individual market (3 on exchange, 2 off)...but one of those is "Freedom Life" which is a phantom carrier; another is Golden Rule which only has about 120 enrollees; and two of the others are divisions of Aetna, which is dropping out of Delaware's indy market next year altogether. That leaves just Highmark BCBS, unless Golden Rule has surprised me by enrolling a significant number of people off-exchange this year.
A couple of days ago, Trump's CMS division of the HHS Dept. released a Q1 2017 ACA exchange effectuation report. This should have been of mild interest to data geeks like me but not especially controversial...except that, as I noted at the time, they played fast & loose with which enrollment/payment data they did and didn't include. As a result, the report made it look like post-open enrollment attrition was dramatically worse in the first quarter of 2017 than it was in previous years. Instead, when you match up the data to match prior years, it looks like the retention rate as of March is actually pretty much exactly the same, or potentially even slightly better.
Washington (CNN)President Donald Trump told Republican senators lunching at the White House Tuesday the House-passed health care reform bill he celebrated earlier this year was "mean," a source told CNN.
Trump made clear multiple times that he was pleased that the Senate negotiations appeared to be moving away from where the House version of the repeal and replace effort ended up, according to three sources familiar with the meeting.
Trump told the lawmakers that the House bill didn't go far enough in protecting individuals in the marketplace -- and appeared to use that as his rationale for why he has ambiguously called twice for the Senate to "add more money" to the bill.
...But the comment belies the celebratory Rose Garden ceremony Trump hosted earlier this year when the House passed the bill and the President championed it as "incredibly well crafted."
Normally I don't post my Rate Hike Project analysis for a state until I have rate filing data available for all (or nearly all) of the individual market enrollees on hand.
I'm making an exception in the case of Michigan, however, because a) it's my home state, and b) My wife, son and I happen to be enrolled in an ACA exchange policy ourselves, via Blue Care Network (the HMO division of Blue Cross Blue Shield of Michigan).
Unfortunately, as of today (6/13) only one carrier has submitted their 2018 rate filing for the ACA-compliant individual market...and it's BCBSMI itself. That is, the PPO division of Blue Cross, not the HMO division.
Every summer for the past few years, the CMS division of the HHS Dept. has released a quarterly report stating how many ACA exchange enrollees are still enrolled in effectuated policies as of March 31st of that year.
The precise wording of this is important, because (as Republicans and other ACA detractors have been shouting about since day one), just because someone signus up for a healthcare policy doesn't mean that they actually pay their first month's premium to be enrolled...and even if they do, some of them will then drop their policy a few months later for any number of reasons (new job with benefits, moving to a different state, turning 65 and moving to Medicare, falling on hard times and qualifying for Medicaid or, in some cases...dying).
The first year of ACA Open Enrollment, running from 10/1/13 - 3/31/14, was a bit of a mess, due not only to the technical meltdown at launch but also the whole system being brand-new to everyone on the individual market. A full six months was given for the enrollment period, and even then there was so much pent-up demand at the end of March that an extra 2 weeks was tacked onto the end, for a total Open Enrollment period of 197 days.
Senate Republicans are on track to finish writing their draft health care bill this evening, but have no plans to publicly release the bill, according to two senior Senate GOP aides.
"We aren't stupid," said one of the aides. One issue is that Senate Republicans plan to keep talking about it after the draft is done: "We are still in discussions about what will be in the final product so it is premature to release any draft absent further member conversations and consensus."
...Democratic senators are already slamming Republicans for the secrecy of their bill writing process, and this isn't going to help. Republicans are sure to release the bill at some point, but it's unclear when — and they want to vote on it in the next three weeks, before the July 4 recess.