Charles Gaba's blog

2018 MIDTERM ELECTION

Time: D H M S

A few days ago, the Centers for Medicare & Medicaid released three important new reports on the 2018 Open Enrollment Period and trends in the individual market. There's a lot of data to go over, so I'm breaking my analysis into several smaller posts for easier readability.

OverviewPart OnePart TwoPart ThreePart Four

Next, let's take a look at the average unsubsidized monthly premiums and APTC subsidies in each year. I've already crunched all of these data before, but that was based on the QHP selctions from the 2017 and 2018 Open Enrollment Periods. The table below is more accurate since it reflects the actual average premiums and subsidy amounts for all of 2017 and for 2018 after subtracting out nearly all of those who never actually paid for their first month of coverage. The numbers for each state and nationally should be close but slightly different:

A few days ago, the Centers for Medicare & Medicaid released three important new reports on the 2018 Open Enrollment Period and trends in the individual market. There's a lot of data to go over, so I'm breaking my analysis into several smaller posts for easier readability.

OverviewPart OnePart TwoPart ThreePart Four

OK, next up: HOW MANY HAVE PAID???

Whew! Georgia only has 4 carriers participating in the individual market, but tracking down some of the data was a royal pain in the butt, especially Ambetter/Centene, which not only buried the numbers I needed inside a whopping 1,900-page PDF file, but the actual average requested rate increase wasn't even included; for that I had to check a different file. Yeesh.

The good news is that carriers in Georgia are only requesting around a 6.1% average rate increase for ACA-compliant individual market policies next year.

The bad news is that if it weren't for the ACA's individual mandate being repealed and the Trump Administration's expansion of #ShortAssPlans, 2019 premiums would likely be dropping by around 5.8% instead.

NOTE: My broadband connection has been experiencing a lot of problems lately; I have a service guy on his way out today for the fourth time in the past two weeks, but this means I'll likely be offline for a few hours, so this post will be incomplete for awhile.

Yesterday, the Centers for Medicare & Medicaid released three important new reports. I did an initial write-up about their overall findings yesterday; today I'm taking a deeper look at the actual reports themselves.

First up, the February 2018 Effectuation snapshot report:

This Just In...

Centers for Medicare and Medicaid Services Releases Reports on the Performance of the Exchanges and Individual Health Insurance Market
Reports show individual market erosion and increasing taxpayer liability

Um...yeah, deliberately sabotaging the ACA a dozen different ways and cutting off CSR reimbursement payments, thus forcing the carriers to load CSR costs directly onto premiums, which in turn jacks up APTC subsidies accordingly, will have the effect of "increasing taxpayer liability"). Go on...

Last summer, as part of his blatant and openly-declared attempt to undermine and sabotage the Affordable Care Act, Donald Trump's HHS Dept. slashed the marketing budget for HealthCare.Gov, the federal ACA exchange, by a whopping 90% (from $100 million to just $10 million), while also cutting the navigator/outreach budget by 41% (from $59 million down to $36 million). On top of this, they also proceeded to confuse the hell out of the grantees of those remaining funds by not providing any information or details before sending out the funds...and then changing their minds at the last minute in many cases and pulling the checks literally moments before they were supposed to be put in the mail. They also slashed the Open Enrollment Period itself in half while they were at it, from 3 months down to just 6 weeks.

On November 8, 2010--right after the "Red Wave" midterm election in which Republicans picked up a jaw-dropping 63 seats in the U.S. House of Representatives, 6 Senate seats and 680 state legislative seats--Paul Waldman wrote, in The American Prospect:

In charting the last two years, from the euphoria of election night 2008 to the despair of election night 2010, I keep returning to Mario Cuomo's famous dictum that you campaign in poetry but govern in prose. The poetry of campaigning is lofty, gauzy, full of possibility, a world where problems are solved just because we want them to be and opposition melts away before us. The prose of governing is messy and maddening, full of compromises and half-victories that leave a sour taste in one's mouth.

...All else being equal, this means Republicans have an easier time getting elected and a harder time legislating the things they really want to do (other than tax cuts, which are never a hard sell), while Democrats have a harder time getting elected but ought to have an easier time legislating.

For nearly a year, healthcare wonks like myself, David Anderson, Andrew Sprung and Louise Norris have been heavily getting the word out to promote not just the "Silver Loading" CSR-load workaround, but an even more clever variant which I've coined "the Silver Switcharoo" which takes the concept of Silver Loading and goes one step further.

It gets a bit complicated, but here's my explainer of how the Silver Switcharoo works for ACA individual market policies.

The bottom line is that in theory/on paper, just about everyone either comes out ahead or at least is no worse off if they use silver switching:

*(OK, these are technically only "semi-approved" rates...there could still be some additional tweaks later on after public comment, etc.)

Oregon was the fourth state which I ran a preliminary 2019 rate increase analysis on back in May. At the time, I concluded that insurance carriers were requesting a weighted average increase of 10.5% for ACA-compliant individual market policies next year. I knew that Oregon's state-based Reinsurance program was helping keep that average down to some degree, but I didn't know exactly how much of a factor it was.

I also knew that efforts to sabotage the ACA by Donald Trump and Congressional Republicans would play a major role in increasing 2019 rates: Repeal of the individual mandate is a big factor, along with the unnecessary 1-point increase in the state exchange fee being imposed on Oregon and the other four states which run their own exchange but "piggyback" on HealthCare.Gov's technology platform.

 

*As I explained 3 years ago:

Basically, Republicans have gone from saying "screw the poor" to "OK, you can see a doctor but only if you dance for me first."

ca·pri·cious (kəˈpriSHəs,kəˈprēSHəs/adjective): given to sudden and unaccountable changes of mood or behavior.

"a capricious and often brutal administration"

synonyms:fickle, inconstant, changeable, variable, mercurial, volatile, unpredictable, temperamental

HUGE. This doesn’t just impact Kentucky, it also has implications for Michigan, Ohio, Arkansas, Indiana...

This article from KTVQ is excellent for my purposes. It clearly and cleanly plugs in just about all of the hard numbers I need to run my rate hike analysis: Which carriers are participating in the 2019 ACA individual market; how many current enrollees each carrier has (both on and off the exchange); and the exact average increase each one is requesting for next year!

Health insurers selling individual policies on the “Obamacare” marketplace in Montana are proposing only modest increases for 2019, on average – or, no increase at all.

State Insurance Commissioner Matt Rosendale released the proposed rates Thursday, with Blue Cross and Blue Shield of Montana proposing an average increase of zero – and a 4.9 percent decline for small-group policies.

The other two companies selling policies on the online marketplace, PacificSource and the Montana Health Co-op, proposed average increases of 6.2 percent and 10.6 percent for individual policies, respectively, and lesser increases for small-group policies.

A couple of days ago, the nonpartisan Kaiser Family Foundation posted an important new analysis (actually a follow-up version of an earlier one they did in May) which proved, in several different ways, that after years of turmoil, the ACA's individual market had finally stabilized as of 2017...or, at least, it would have if not for the deliberate sabotage efforts of one Donald J. Trump and several hundred Congressional Republicans. This included hard numbers for the first quarter of 2018 which showed the trend continuing in a dramatic fashion.

Following up on that, they went further yesterday and posted a whole bunch of handy raw individual market data for the 2011 - 2017 calendar years at the state level, including the average gross profit margin per member per month as well as the share of premiums paid out as claims in every state (except, frustratingly, California).

This Just In...

State’s Market Stability Workgroup Recommends Immediate Action to Protect Rhode Islanders from Federal Threats to Health Insurance Access and Affordability

Posted on June 27, 2018 | By HealthSource RI

EAST PROVIDENCE, R.I. (June 27, 2018) – Rhode Island must act “without delay” to protect consumers from rising health coverage costs brought on by federal policy changes according to a report issued to Governor Raimondo by the state’s Market Stability Workgroup.

“People representing a wide variety of viewpoints engaged in lively discussions over the course of 8 weeks,” said Workgroup co-chair Bill Wray, Chief Risk Officer at the Washington Trust. “The fruits of those discussions are in this report. All of us – consumer advocates, business groups, health insurers and providers – were able to broadly agree on how best to protect Rhode Island’s insurance markets.”

*(technically Vermont was the third to do so, but theirs doesn't kick into effect until 2020, and they haven't even crystalized exactly what form it would take anyway.)
**(yeah, I know very well that DC isn't actually a state, but it's pretty awkward to put "state and/or territory" in the headline.)

I realize that 110% of the news/media/political attention is on the bombshell announcement that Supreme Court Justice Anthony Kennedy is retiring at the end of July, but there are other things going on as well, so I'll do my best to soldier on...

More big health care action at the state level: yesterday the DC Council passed what would be the nation's third state-level individual mandate, after Mass. and NJ.https://t.co/BmtnDAQvVp

— Jason A. Levitis (@jasonlevitis) June 27, 2018

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