But that's not all! In addition to the actual 2018 MLR rebates, I've gone one step further and have taken an early crack at trying to figure out what 2019 MLR rebates might end up looking like next year (for the Individual Market only). In order to do this, I had to make several very large assumptions:
Hawaii only has two carriers participating in the Individual health insurance market. For 2020, they're reducing unsubsidized premiums slightly.
The state's small group market has four carriers; unfortunately, only one of the four (Kaiser Foundation Health Plan) has posted their enrollment data; the other three are redacted. The unweighted average increase on the small group market is a mere 0.8%, however.
With the 2019 Open Enrollment Period quickly approaching, I'm spending a lot of time swapping out the requested carrier rate changes from earlier this summer with the approved rate changes from state regulators.
Hawaii only has two carriers participating in the ACA-compliant individual market: HMSA and Kaiser, which requested rate increases of 2.72% and 28.6% respectively back in August. With a roughly 57/42 market share split, this resulted in a weighted average rate increase of 13.8%, which would likely have been closer to 3.8% if the ACA's individual mandate penalty hadn't been repealed.
It took me four full months for me to analyse the 2019 ACA rate filings for the first 30 states, but the remaining 20 should come fast & furious starting today, because it looks like they were all finally uploaded to the official RateReview.HealthCare.Gov website earlier this afternoon.
Case in point: Hawaii. There's four carrier listings at RR.HC.gov, but this is misleading; two of them are basically double-listed (Hawaii Medical Service Association separated out their PPOs and HMOs into separate listings, but the filing itself merges both; the same is true of Kaiser Foundation Health Plan, whish has On and Off-Exchange policies listed separately in the database but again merges them into the same filing). In reality, Hawaii only has two carriers on the Individual Market as they have for years.
Gov. David Ige signed a new law on Thursday that ensures certain benefits under the Affordable Care Act will be preserved under Hawaii law.
Senate Bill 2340 retains several of the measures introduced in the Obama-era legislation, also known as Obamacare, including a clause that allows Hawaii adults up to 26 years-old to continue receiving health insurance under their parents.
The law also prohibits health insurance organizations from excluding coverage to those with preexisting conditions, or using an individual's gender to determine premiums or contributions to health insurance plans.
For a couple of months now, I've been attempting to track a slew of state-based "ACA 2.0" bills slowly winding their way through various state legislatures. However, this is really a bit of a misnomer, since some of these bills aren't so much about expanding the ACA as they are about protecting it from various types of undermining or sabotage from the Trump Administration and Congressional Republicans.
Once again: The "Blue Leg" of the Stool covers everything which ACA-compliant individual health insurance carriers are required to include: Guaranteed Issue, Community Rating, 10 Essential Health Benefits, a Minimum 60% Actuarial Value rating, no Annual or Lifetime Caps on coverage, and a long list of mandatory Preventative Services at no out-of-pocket cost when done in-network.
According to our CSR Load Load spreadsheet, Hawaii is supposed to be one of the 20-odd states using the full "Silver Switcharoo" strategy. It also has a single Rating Area, and only has two carriers (Kaiser and HMSA) participating in the individual market (on or off-exchange) anyway, making it a pretty easy state to run a full apples-to-apples year over year comparison.
Kaiser is offering a total of 11 plans on the ACA exchange (3 Bronze, 3 Silver, 3 Gold and 2 Platinum), while HMSA lists 10 (2 Bronze, 3 Silver, 3 Gold and 2 Platinum). I couldn't run a perfect comparison to 2017 since each carrier changed a couple of their offerings, but it's pretty darned close.
With only 5 days to go before the launch of the 2018 Open Enrollment Period, time is rapidly running out for me to wrap up my 2018 Rate Hike Project. I started this, as I have for 3 years now, back in late early May with the very first requested rate changes out of Virginia, and have been tracking all 50 states as the summer and fall have passed, following every twist and turn of the insane repeal/replace circus in Congress, Trump's bloviating and blathering about "blowing things up" and "letting Obamacare explode", the last-ditch "Graham-Cassidy" sideshow and everything else, right up to and through Trump lowering the boom on cutting off CSR reimbursement payments.
Hawaii only has two carriers on the individual market (and in fact doesn't even have much of an individual market due to a state law mandating that nearly every business provide coverage anyway). HMSA's filing letter is very specific about calling out both the CSR and mandate enforcement sabotage factors as being part of their request. Kaiser doesn't really mention either issue at all, and the only CSR reference in the filing seemed to assume it would be paid, so I have one in each category. Kaiser Family Foundation assumes a 21% Silver CSR rate hike, and 71% of Hawaii's exchange enrollees are on Silver plans, so that amounts to roughly a 15% overall CSR factor.
Here's what it looks like...15.2% w/partial sabotage, 30.2% with full sabotage:
As of 2017, Hawaii no longer has a SHOP exchange for small businesses. The State Department of Labor and Industrial Relations has an FAQ page about this.
...Hawaii’s waiver aligns the ACA with the state’s existing Prepaid Health Care Act. Under the Prepaid Healthcare Act, employees who work at least 20 hours a week have to be offered employer-sponsored health insurance, and can’t be asked to pay more than 1.5 percent of their wages for employee-only coverage (as opposed to 9.69 percent under the ACA in 2017).
As I'm sure some readers have noticed, I haven't posted any updates since Friday, which is highly unusual for me, especially with open enrollment rapidly approaching. I'm afraid that due to an unfortunate coincidence of timing, I have an outside personal commitment which will be eating up a lot of my time for the next 4 weeks; as a result, expect posts to be lighter than usual.
Kaiser's 25.9% request was approved as is; HMSA's 43.3% was shot down originally; they later resubmitted it at 35%, which was then approved.
You may also notice that I've started making sure to include UNSUBSIDIZED in the headlines for all of these rate hikes. This is vitally important to remember, even if it's only relevant to around 50% of individual market enrollees.
Lots of stuff happening fast & furious these days as #OE4 approaches. Instead of individual posts, I'm gonna cram 7 state updates into a single one...and am also cheating a bit by cribbing off of excellent work by Louise Norris over at healthinsurance.org (which is fair, since she also gets some of her data from me as well):
ALABAMA: Here's what my requested rate hike table looked like for Alabama on August 1st:
As I noted Monday morning, I believe that August 1st was the deadline for every state to submit their 2017 rate filings, meaning that the 14 states missing from my Requested Rate Hike Project are finally available to be plugged into the spreadsheet. I'll also be going back through the other states I've been tracking since as early as April to see which ones require updates due to carriers dropping out, joining in or resubmitting their rate requests.
There are only two insurance carriers participating in Hawaii's individual market next year: The Hawaii Medical Service Association (HMSA) and the Kaiser Foundation Health Plan.
But actually, he thought as he re-adjusted the Ministry of Plenty’s figures, it was not even forgery. It was merely the substitution of one piece of nonsense for another. Most of the material that you were dealing with had no connexion with anything in the real world, not even the kind of connexion that is contained in a direct lie. Statistics were just as much a fantasy in their original version as in their rectified version. A great deal of the time you were expected to make them up out of your head. For example, the Ministry of Plenty’s forecast had estimated the output of boots for the quarter at 145 million pairs. The actual output was given as sixty-two millions. Winston, however, in rewriting the forecast, marked the figure down to fifty-seven millions, so as to allow for the usual claim that the quota had been overfulfilled. In any case, sixty-two millions was no nearer the truth than fifty-seven millions, or than 145 millions. Very likely no boots had been produced at all. Likelier still, nobody knew how many had been produced, much less cared. All one knew was that every quarter astronomical numbers of boots were produced on paper, while perhaps half the population of Oceania went barefoot.
As anyone who's been following the ACA exchange saga over the past few years knows, the original idea was that all 50 states (+DC) would establish their own, individual healthcare exchange, including their own website/technology platform for enrolling residents in private policies (QHPs), Medicaid (supplementing or replacing whatever existing Medicaid system they already had) and small business policies (the ACA's SHOP program). In addition, each state exchange would also have their own board of directors, marketing department, support call center, fee structure for covering the cost of operations and so on.
If things had worked out that way, there would have been 51 different websites where people would enroll in ACA policies, each one independently branded.