California

Me, last Thursday:

There you have it: The states which are 100% on board with the ACA exchange provisions (running their own full state-based marketplace, expanding medicaid and sticking to the original cut-off date for "transitional" policies) average around 18%. If you remove Minnesota from the equation, it's just 15.2%.

Those which implemented only one or two of the above provisions come in at around 26%. In a possibly coincidental quirk, all five fo the "halfway" state exchange states (Hawaii, Oregon, Nevada, Kentucky and New Mexico) just happen to also fall into this category as well, which is completely appropriate.

Finally, states which are fighting the ACA kicking and screaming (no Medicaid expansion, no state exchange and allowing transitional plan extensions as long as possible) are averaging around 30%.

Make of that what you will.

Huh. OK, it looks like three of the ACA state-based exchanges have already launched their 2017 window shopping tools: Idaho, Maryland and California!

The other two announced that their 2017 offerings were open for business via press releases, but it looks like CoveredCA just quietly opened the doors without any fanfare. I stumbled across this by simply visiting the CoveredCA site and clicking the "Shop & Compare" link at the top, which now lists 2017 as the default Coverage Year (you can still choose 2016 if you need to enroll for the rest of this year via SEP). Plugging in some dummy info confirms that the plans are indeed set to start on 01/01/17.

I don't usually post a whole lot about the small group market (other than occasionally trying to track how many SHOP enrollees there are by state and nationally), but this seems like pretty good news given how chaotic the individual market continues to be...

Covered California for Small Business Announces Rate Change and Expanded Coverage Choices for 2017

  • Statewide weighted average rate increase is less than 6 percent.
  • Blue Shield of California expands to Full PPO network statewide.
  • Kaiser Permanente moves into Santa Cruz County.

SACRAMENTO, Calif. — Covered California announced today the rates and expansion plans for its small group health insurance exchange, Covered California for Small Business. The statewide weighted average rate increase is 5.9 percent, for employers and their employees beginning Jan. 1, 2017, which is down from the 7.2 percent increase in 2016.

Thanks again to commenter "M E" for finding this Business Insider article in which health insurance startup Oscar Insurance Co. has announced that they're pulling out of the ACA exchange completely in New Jersey, and out of the Dallas market specifically in Texas...while also expanding into San Francisco next year:

According to a release from the company on Tuesday, the firm will no longer offer individual market plans through the Affordable Care Act in Dallas, Texas, and New Jersey.

..."We hope to return to these markets as we carry on with our mission to change healthcare in the US."

The "we hope to return" part suggests that Oscar will continue to be available off the exchange in New Jersey, since completely pulling out of a state means a carrier has to wait at least 5 years before re-entering. So...there's that, anyway.

...Oscar currently covers 7,000 people in Dallas and 26,000 in New Jersey.

Back in early May, Covered California, the largest state-based ACA exchange in the country, issued their proposed 2016-2017 budget, which included this tidbit:

California’s health insurance exchange estimates that its Obamacare premiums may rise 8 percent on average next year, which would end two consecutive years of more modest 4 percent increases.

The projected rate increase in California, included in the exchange’s proposed annual budget, comes amid growing nationwide concern about insurers seeking double-digit premium hikes in the health law’s insurance marketplaces.

...Insurers in California have submitted initial rates for 2017, but the final figures won’t be known until July after state officials conduct private negotiations.

Chad Terhune reported today that Covered California, the largest state-run ACA exchange in the country, released their 2016-2017 fiscal year projected budget, which includes a mountain of useful enrollment data...some of which is positive, some negative and some of which depends on your POV:

California’s health insurance exchange estimates that its Obamacare premiums may rise 8 percent on average next year, which would end two consecutive years of more modest 4 percent increases.

The projected rate increase in California, included in the exchange’s proposed annual budget, comes amid growing nationwide concern about insurers seeking double-digit premium hikes in the health law’s insurance marketplaces.

...Insurers in California have submitted initial rates for 2017, but the final figures won’t be known until July after state officials conduct private negotiations.

About a year ago I wrote about a bill working it's way through the California state legislature which, if passed and signed into law, would have allowed all of California's 1.5 million uninsured, undocumented immigrants to either enroll in Medi-Cal (CA's name for Medicaid) or in ACA exchange policies via Covered California (with the state picking up the tab for the APTC/CSR financial assistance). Since the ACA specifically prohibits any federal dollars from being used, the state would be on the hook for 100% of the cost.

The bad news is that this ambitious bill didn't end up making it through the process. The good news is that a stripped-down version of it did become law:

According to the Kaiser Family Foundation, California averaged around 7.8 million Medicaid/CHIP enrollees prior to the ACA; this number has since shot up about 58%, to 12.3 million people.

One of the chief arguments in favor of the ACA has always been that uninsured people tend to not get treated for ailments/injuries at all (for obvious reasons), and then end up going to the emergency room when that gangrenous foot leaves them no choice. Not only does this end up costing much more to treat, the hospital is also stuck footing the bill (no pun intended) since the uninsured also tend not to have any money to pay out of pocket either (if they did, the odds are that they'd have some form of insurance, after all).

Covered California held a press call a few minutes ago in which they released detailed enrollment numbers for the 2016 Open Enrollment Period, broken down a number of different ways, including by rate region and individual carrier market share. They even broke the individual numbers out between renewals and new enrollees.

Unfortunately, I only caught half the call, but the full press release should be coming out momentarily which is supposed to have all of the numbers broken out every which way.

Until then, here are some oddball key points from the call:

Hmmm...this was unexpected:

ALERT! If you started enrolling by 1/31 deadline but unable to finish due to recent snowstorm, you may finish by 2/5 pic.twitter.com/U9X3QhTIT9

— MD Health Connection (@MarylandConnect) January 29, 2016

I'm surprised by this for several reasons. The snowstorm was nearly a week ago, and there's still 3 days left for people to enroll as it is; are there still a lot of areas of Maryland coping with power outages/other disruptions which are making it unreasonable to expect people to get in under the wire?

Second, because CMS just stated pretty unequivocally that HealthCare.Gov will not be offering any official deadline extension (although, like the MD exchange, they did say that they'll have an "in line by midnight" exception). I assumed that if HC.gov was taking a "hard line stance" that the state exchanges would as well.

This Just In...

SACRAMENTO, Calif. — Covered California announced that a surge of consumers interested in affordable, quality health care coverage had signed up through the agency this week. Through Jan. 27, more than 329,000 new enrollees had picked a health coverage plan during the current open-enrollment period. In addition, more than 148,000 new and renewing consumers had enrolled in the new optional family dental coverage.

As always, CoveredCA is happy to tout their new enrollees but has a weird thing about keeping mum on the number who renewed policies from 2015. This would make sense if the renewal number sucked, but it doesn't: The ASPE report through 12/27 clearly states that they had 1,411,664 QHP selections, of which 84% were renewals (automatic or active) by 2015 enrollees.

84% of 1,411,664 = roughly 1,186,000. Add 329K to that and you get 1.515 million QHP selections to date.

The final 2016 deadline to enroll in a qualifying healthcare plan for policies starting coverage as of March 1st officially ended as of MIDNIGHT on January 31st.

As usual however, there are a few caveats to this...but not as many as the past two years:

OK, so I've just received word that Covered California has added exactly 290,137 new QHP enrollees as of January 18th.

This compares with the 238K new enrollees as of January 2nd, so that's around 52,000 additional people from 1/03 - 1/18, or 3,466 per day.

The official ASPE report, which ran through 12/27/15 for California, had their tally at 1,411,664, of which 84% were re-enrollees from 2015, which should be around 1.186 million.

Add 290K to that and you're up to roughly 1.476 million people.

My official target for California is 1.80 million, so CoveredCA has reached 82% of where I was expecting them to be by now...which is right in line with where I think things stand nationally.

Covered California sent out an interesting press release today:

Democratic Leader Nancy Pelosi visited the University of California, San Francisco (UCSF), today to highlight a new report showing that thousands of Californians who have obtained health insurance as a result of the Patient Protection and Affordable Care Act have received vital treatment — including brain surgeries, heart transplants, cancer treatment and trauma care — since January 2014, when the health exchange opened its doors.

“Today’s report is the latest evidence that the Affordable Care Act is delivering on the promise of making health care a right for all, not just a privilege for the few,” Pelosi said. “Covered California has been an enormous success. Thanks to this historic law, nearly 1.3 million Californians now have affordable coverage through the Covered California marketplace — and this data today makes clear that Californians are using this coverage to access vital, high-quality health care.”

Every time Covered California issues a press release, it's like Lucy pulling away the football from Charlie Brown; I always think that this time they're gonna finally let me know how many current ACA exchange enrollees have re-enrolled for 2016...but it never has that number included. Considering that it could potentially be as high as 1.3 million people, that's kind of a big deal (although I realistically expect the number to be somewhere between 1.0 - 1.2 million at most).

Anyway, today is no exception: Zilch on the renewal numbers (and not even any updated new enrollment figures since the 197K they announced as of 12/15)...although they did include one interestingly-worded tidbit which is subject to quite a bit of speculation:

Covered California Highlights Major Health Insurance Changes for the New Year — New Penalties, New Requirements and, for Those With Coverage, Improved Benefits, More Options and More Access to Care

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