California

2018 MIDTERM ELECTION

Time: D H M S

With the 2019 Open Enrollment Period rapidly approaching, I figured this might be a good time to remind everyone that while it starts on November 1st for most of the country, the largest state, California, is kicking things off 2 weeks early (17 days early, actually). Covered California is launching their 2019 ACA Open Enrollment Period on Monday, October 15th, 2018:

Open enrollment for 2019 coverage will begin October 15, 2018 in California, and continue until January 15, 2019

Nationwide, open enrollment for 2019 coverage is scheduled to run from November 1, 2018 to December 15, 2018 — the same schedule that was followed in late 2017 for 2018 coverage. But Covered California was one of only three state-run exchanges that opted in 2017 to keep open enrollment at three months in duration for 2018 coverage (the others were New York and DC).

And the state enacted legislation (A.B.156) in late 2017 that codifies a three-month open enrollment period going forward — California will not be switching to the November 1 – December 15 open enrollment window that other states will be using.

It's been awhile since I last updated my "ACA Protection Spreadsheet", which is an attempt to track a whole mess of bills designed to protect the Affordable Care Act from sabotage at the federal level by the Trump Administration and Congressional Republicans. My last update was over a month ago, when Hawaii's Governor signed a law which locks in several ACA protections, including:

  • Ensure that young adults can continue to remain on their parents’ health insurance plans until age 26
  • Prohibit insurers from using applicants’ gender to set premiums
  • Prohibit insurers from rejecting an application based on an applicant’s medical history, or imposing coverage exclusions based on pre-existing conditions.

Today, however, there were major developments regarding #ShortAssPlan restrictions (and a few other important patient protection bills) in three states: Two positive, one negative.

CALIFORNIA:

California's contains over 12% of the entire U.S. population, around 13% of total ACA exchange enrollment and nearly 16% of the total ACA individual market. As such, when they make any announcements about their ACA exchange policies (or in this case, 2019 premiums), it's a pretty big deal for the national averages.

Today, Covered California, the largest state-based ACA exchange, announced their proposed 2019 ACA premium changes:

Covered California Releases 2019 Individual Market Rates: Average Rate Change Will Be 8.7 Percent, With Federal Policies Raising Costs

Over the past few weeks I've noted that a half-dozen states or so (Maryland, New Jersey, Vermont, Hawaii, California and Illinois) have been pushing through a long list of bills/laws at the state level to either protect the ACA from sabotage or even strengthen it. Meanwhile, other states have either expanded Medicaid under the ACA (Virginia, of course) or have locked in ballot measures to do so this fall (Utah, Idaho). Finally, several states have announced they're joining dozens of others to take advantage of "Silver Loading" or full-on "Silver Switching".

Well, things haven't slowed down. Just a few days after eight different ACA/healthcare bills passed out of either the state Senate or Assembly, California legislators have passed several more:

UPDATE: Thanks to Anthony Wright, Executive Director of Health Access California, for clarifying a few things on some of these bills.

A couple of months ago Louise Norris of healthinsurance.org gave me a heads up about a half-dozen or so healthcare bills, mostly ACA-related, pending in the California state legislature. Some were in the state Senate, some in the state Assembly; some were more along the lines of protecting the ACA from sabotage efforts while others were about expanding upon the law.

Well, today a whole bunch of those bills (as well as a few I didn't even know about earlier) made it a major step further along the line to becoming law. Courtesy of the Health Access CA Twitter feed:

About a month and a half ago, state legislators in California introduced a bold new "All-Payer" healthcare bill which, had it become law, would have regulated the actual price of various types of medical procedures. As Sarah Kliff explained in Vox at the time:

California is exploring a bold and controversial new plan to rein in health care spending by letting the state government set medical prices.

...Still, California’s new proposal is worth examining as one that steps closer to single-payer — but doesn’t go quite all the way. It’s one plausible step a state could take without any assistance from the Trump administration, as we see more blue states looking for ways to shape the future of their own health care systems.

”I think we have appreciated how much we’ve been able to do with transparency and data, and how much we’ve been able to collect, but we reached the point where we felt like we had to tackle the issue of prices head on,” says Sara Flocks, policy coordinator for the California Labor Federation, which is backing the proposal.

Covered California Launches New Campaign Focused on College Graduates to Make Sure They Get Health Coverage

  • Commencement speakers will remind thousands of new graduates that “life can change in an instant” – making it important for them to have health coverage, so they can get the health care they need as they set out in life.
  • A new video distributed on social platforms will remind graduates who may be losing their health coverage to check out Covered California for affordable options.
  • Covered California Executive Director Peter Lee congratulates graduates and reminds them to protect their futures by getting health insurance.
  • Covered California provided more than 70 campus health centers with materials to educate graduating students about new health insurance options available through Covered California
  • The “special enrollment” campaign for graduates is launching amid new data showing California’s uninsured rate is at an all-time low.

SACRAMENTO, Calif. — Graduation season is in full bloom and Covered California is joining with commencement speakers throughout the state to remind the over 400,000 graduates and their families not to forget about the importance of health insurance during this busy time of year.

This evening brought three major pieces of ACA-related news out of three different states:

First, in California, the State Senate passed SB-910, which wouldn't just limit short-term plans, but would outright prohibit them altogether. To my knowledge, CA would be the only state* where STPs wouldn't be allowed at all:

(*Correction: It turns out that New York, New Jersey and Massachusetts also ban Short-Term Plans as well, although according to Dania Palanker of the Center on Health Insurance Reforms at Georgetown University, California would be the first state to explicitly outlaw short-term plans as opposed to simply stating that all policies have to meet certain standards.)

SACRAMENTO – Today, the State Senate approved passage of Senate Bill 910, which prohibits the sale of short term limited duration health insurance in California.

OK, this doesn't technically count as an official 2019 Rate Hike analysis since none of it comes from actual carrier rate filings, but Covered California, the largest state-based ACA exchange, just released their proposed 2018-2019 annual budget, and it includes detailed projections regarding expected premium increases and enrollment impact over the next few years due specifically to the GOP's repeal of the ACA's Individual Mandate. Oddly, while they mention short-term plan expansion as another potential threat to enrollment/premiums, they do so passingly, and they don't mention association plans at all:

Since 2014, nearly 5 million people have enrolled in Medi-Cal due to the Affordable Care Act expansion, and more than 3.5 million have been insured for some period of time through Covered California. Together, the gains cut the rate of the uninsured in California from 17 percent in 2013 to a historic low of 6.8 percent as of June 2017.

Covered California Analysis Shows Major Declines in New Enrollment Nationally and Identifies Policies That Could Lower Premiums in 2019

  • Enrollment in the federally facilitated marketplace has dropped 9 percent over the past two years, with a nearly 40 percent drop in new enrollment, while enrollment in state-based marketplaces remained steady during the same period.

Nothing new under the sun here; this is the core of what I do at ACASignups.net. In fact, this press release underplays the point slightly: The official enrollment tallies are down 10% on the federal exchange since 2016 and up 1.5%, although the discrepancy might be partly due to Kentucky shifting from state-based status to federal status in 2017.

The California Health Care Foundation is a nonprofit philanthropic organization. From their About page:

The California Health Care Foundation is dedicated to advancing meaningful, measurable improvements in the way the health care delivery system provides care to the people of California, particularly those with low incomes and those whose needs are not well served by the status quo. We work to ensure that people have access to the care they need, when they need it, at a price they can afford.

Over the past few weeks, in the midst of the failed Republican-sponsored "ACA stabilization bill" known as Alexander-Collins (which laughably included "Bipartisan" in the title evne though it had changed dramatically from the actual bipartisan bills which Senators Patty Murray and Bill Nelson had worked with Lamar Alexander and Susan Collins on last fall), Democrats in both the House and Senate introduced real ACA stabilization/improvement bills of their own.

The official names of these bills are the "Undo Sabotage and Expand Affordability of Health Insurance Act of 2018" (USEAHIA) and the "Consumer Health Insurance Protection Act" (CHIPA) respectively, but for pretty obvious reasons I'm shortening each of them to simply "ACA 2.0".

OK, this is just kind of...odd.

As regular readers will recall, after three years of full 3 month Open Enrollment Periods across every state, last year the Trump Administration slashed the official Open Enrollment Period in half, down to just 6 weeks, from November 1 - January 31 down to November 1 - December 15th.

In response, most of the state-based exchanges announced that they were sticking with a longer period anyway, ranging anywhere from a 7th week all the way out to the full 3 month period, in the case of California, New York and the District of Columbia...each of which kept things going all the way through January 31st as had become the norm.

California even went one step further, passing a state law specifically mandating a 3-month Open Enrollment Period for 2018 and beyond.

Until today, I've been operating on the assumption that they'd be sticking with the November/December/January schedule which had become the default.

Apparently not, however. According to Louise Norris:

Today, Covered California issued a new study about the projected impact of Donald Trump and Congressional Republican efforts to undermine and sabotage the Affordable Care Act not just in 2019, but over the next 3 years. They main focus is on two sabotage moves which have already happened (repeal of the individual mandate and the shortened/underfunded marketing of the open enrollment period on the federal exchange) and one which is on the verge of happening (Trump's "Short Term and Association Plan" executive order, aka #ShortAssPlans).

Here's what they concluded:

Covered California’s Executive Director Addresses Harvard Study on Impact of Eliminating Individual Mandate on Enrollment and Premium

SACRAMENTO, Calif. — Covered California Executive Director Peter V. Lee issued the following statement in connection with the Harvard Medical School Study, “Eliminating the Individual Mandate Penalty in California: Harmful but Non-Fatal Changes in Enrollment and Premiums,”published in Health Affairs. The Harvard study, conducted by a team lead by Dr. John Hsu, is the first national effort to measure the potential impacts of removing the individual mandate penalty based on surveying actual California consumers about their likely actions in the face of there being no penalty.

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