As I've noted several times, one of the biggest flaws in the Affordable Care Act is a very simple one on paper: The Subsidy Cliff. People who enroll in ACA exchange policies are entitled to financial assistance on a sliding scale...but only if their household incomes fall between 100-400% of the Federal Povery Level. Those below the lower threshold (actually, below 138% FPL) are expected to enroll in Medicaid, but those over the upper threshold of 400% FPL (around $50,000/year for a single person, roughly $103,000/year for a family of four) are completely on their own.
Here's the current federal premium subsidy formula (the precise premium cap percentages change slightly from year to year...and the Trump Administration is even messing with that a bit, so I'm not sure what it'll be in 2020):
In other words, only about 10% (at most) of those still in the Medicaid Gap could even remotely match the GOP's cliche of a "lazy, good-for-nothing layabout" type who's able-bodied, has no serious extenuating circumstances and so forth. The "get off your ass and work!" requirements appear to be nearly as big a waste of time and resources as the infamous "drug testing for welfare recipients" bandwagon which a bunch of states jumped on board over the past few years.
One Ohio resident paid $240 a month for health insurance that she later learned didn’t cover her knee replacement. Saddled with $48,000 in medical bills, she decided not to get the other knee replaced.
...A Kansas resident paid premiums on a policy for two years, then found out his insurance would not cover surgery for a newly diagnosed cancer.
The two policyholders have filed a lawsuit in federal court against Health Insurance Innovations, based in Tampa, Fla., accusing the company of misleading them about the kind of policy they were buying.
They say they believed they were purchasing Affordable Care Act plans that include coverage guarantees. But they were sold much less comprehensive coverage that left them vulnerable to tens of thousands of dollars in unpaid medical bills, according to the lawsuit.
The state of Maine's Bureau of Professional & Financial Regulation has released their preliminary 2020 rate filings for the Individual and Small Group markets. Overall, the three carriers participating in their individual market are seeking a weighted average rate increase of 4.7% vs. last year. If approved as is, that would bring the average unsubsidized premium up from $675/month to $707/month, or around $381/year.
It's important to keep in mind why premiums are going up. I've included screenshots of the rate filing memos--Maine Community Health Options, which holds over 50% of the individual marketshare, clarifies that the combination of the individual mandate being repealed and the expansion of #ShortAssPlans are causing an 11% increase. They also note that Maine's recent Medicaid expansion implementation may be a factor, although normally that reduces premiums since lower-income populations tend to be less healthy than higher-income populations, so I'm not sure what to make of that.
As a reminder, here's the eight bills which passed the full House:
H.R. 938, the "Bringing Low-cost Options and Competition while Keeping Incentives for New Generics (BLOCKING) Act of 2019," introduced by Reps. Kurt Schrader (D-OR) and Buddy Carter (R-GA), would discourage parking of 180-day exclusivity by a first generic applicant that is blocking the approval of other generics.
H.R. 1499, the "Protecting Consumer Access to Generic Drugs Act of 2019," introduced by Rep. Bobby Rush (D-IL), would make it illegal for brand-name and generic drug manufacturers to enter into agreements in which the brand-name drug manufacturer pays the generic manufacturer to keep a generic equivalent off the market.
Bill expanding ‘Insure Oklahoma’ program passes Senate committee
A Senate bill seeking to expand the Insure Oklahoma program has advanced out of committee Monday morning.
Senate Bill 605, authored by Sen. Greg McCortney, R-Ada, directs the Oklahoma Healthcare Authority to implement "the Oklahoma Plan" within Insure Oklahoma. An agency spokesperson said the program provides premium assistance to low-income working adults employed by small businesses.
The latest numbers from Insure Oklahoma show less than 19,000 are enrolled.
According to McCortney, the intent of his bill is to provide insurance for Oklahomans who would qualify for Medicaid in states which opted to expand but are currently not insured.
Last year, I noted several times that regardless of what your opinion may be of the ACA's Individual Mandate Penalty (which was, until this year, either $695 per adult/$348 per child or 2.5% of your household income, unless you received an exemption), one of the key things to keep in mind about the penalty is that any impact it has on encouraging people to go ahead and enroll in ACA-compliant healthcare coverage is entirely dependent on two things:
Last May, I noted that Vermont was supposedly joining Massachusetts, New Jersey (and later in the year, the District of Columbia) in reinstating the ACA's Individual Mandate Penalty, which added an additional tax to people who don't enroll in ACA-compliant healthcare coverage (whether private or public) and who don't qualify for an exemption due to an affordability threshold, hardship or some other qualifying reason.
Strike One:Vermont's mandate won't go into effect until 2020, leaving a one-year gap. This bill getting signed is still good news, but mostly irrelevant for 2019. The "coordinated outreach efforts" part is really more of a counter to the Trump Administration's slashing of the ACA's marketing/outreach budget...but not really, since Vermont already runs their own exchange and should have their own marketing/outreach budget anyway. So this is more of a token gesture, I'd guess.
Along with Massachusetts and Vermont, the District of Columbia merges their Individual and Small Group markets for purposes of risk pools and risk adjustment. This does not, however, necessarily mean that their Indy and Sm. Group average premium changes are identical. For one thing, there are more carriers which offer small group plans than individual market plans; for another, the market share ratios between the two differ.
Washington, DC – The District of Columbia Department of Insurance, Securities and Banking (DISB) received 181 proposed health insurance plan rates for review from Aetna, CareFirst BlueCross BlueShield, Kaiser Permanente and United Healthcare in advance of open enrollment for plan year 2020 on DC Health Link, the District of Columbia’s health insurance marketplace.
Last year individual market carriers here in my home state of Michigan only raised premiums 1.7% on average in 2019, with Oscar Insurance Co. being a new addition to the market. For 2020, they're reducing average premiums by about 2.0%. Oscar made very little headway in their debut year, only enrolling 649 people statewide.
On the surface, it looks like Michigan's total ACA-compliant individual market has plummeted by a whopping 18% (281K vs. 344K last year). However, this can be misleading because the enrollment numbers listed each year only include the number of enrollees actually impacted by the rate changes. For instance, if a carrier pulls out of half the state, then a chunk of their current total enrollment won't be listed since enrollees in that half aren't seeing their current premiums change...they'll be losing coverage altogether and will have to switch to a different carrier.
On Tuesday, May 21, Governor John Bel Edwards issued an executive order launching the Protecting Health Coverage in Louisiana Task Force after efforts to have protections offered to Louisianans with preexisting conditions repealed.
There's another Congressional healthcare hearing going on right now as well, this time in the House Energy & Commerce Committee; this one is on Surprise Billing:
HEARING ON “NO MORE SURPRISES: PROTECTING PATIENTS FROM SURPRISE MEDICAL BILLS”
The Subcommittee on Health of the Committee on Energy and Commerce will hold a legislative hearing on Wednesday, June 12, 2019, at 10 a.m. in the John D. Dingell Room, 2123 of the Rayburn House Office Building. The hearing is entitled, “No More Surprises: Protecting Patients from Surprise Medical Bills.”
The New Mexico Office of the Superintendent of Insurance website just posted the preliminary 2020 insurance rate filings. Here's the full list, which includes a mish-mash of Individual Market, Large Group and Small Group Market policies, with a Pediatric Dental standalone plan thrown in as well.
It's worth noting that the NM carriers are being very careful to separate out on & off-exchange policies into separate listings even though they're all part of the same risk pool, and they're even separating out off-exchange "Mirrored" policies, which refers to CSR Silver Switching; this is a very good thing.
I've cleaned up the listings and plugged in the weighted average rate increases in the table below this one: