Kentucky

2018 MIDTERM ELECTION

Time: D H M S

Hat tip to Louise Norris for the heads up about the Kentucky Dept. of Insurance issuing their final rulings for 2019 ACA individual market and small group policy premiums:

DOI Completes Review of Individual and Small-Group Health Insurance Rate Filings

The Kentucky Department of Insurance (DOI) announced today that it has completed its review of the individual and small-group insurance rates filed in the Kentucky market. The rates will be used to calculate insurance premiums in the 2019 benefit year.

Kentuckians in the individual market will once again experience changes in premiums and plan offerings. The rates that will be used reflect an average rate increase of 4.3 percent for Anthem Health Plans of Kentucky (Anthem) and 19.4 percent for CareSource. Since the actual premium charged will vary by individual and the plan level selected, some individuals may see a decrease in rates.

 

*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...

Kentucky's 2019 preliminary Rate Filings have been posted, and they're pretty straightforward: Like this year, there will only be two carriers offering policies on the KY individual market in 2019: Anthem and CareSource, with roughly a 46/54 market share split.

The overall average requested rate increase is around 12.2% between the two. Neither carrier states just how much of their requested increase is due to mandate repeal or #ShortAssPlans (CareSource did list it...but then redacted it from public view). The Urban Institute projected around an 18.7 percentage point impact; 2/3 of that is around 12.5 points, so that's what I'm assuming until further notice.

Assuming that's accurate, that means that if not for the mandate/shortassplan sabotage factors, Kentucky carriers would be keeping unsubsidized 2019 premiums flat year over year (or even dropping them a smidge).

A week or so ago, I noted that Republicans in my home state of Michigan have come up with a clever way of having their (chocolate) cake and eating the (vanilla) cake too. As first noted by Nancy Kaffer of the Detroit Free Press:

Although HB 897 threatens to end Medicaid benefits for hundreds of thousands living elsewhere in the state, it includes exemptions for people who live in counties with an unemployment rate of more than 8.5%, like the ones Schmidt represents.

Live in Detroit? You're out of luck.

The city's unemployment rate is higher than 8.5%, but the unemployment rate in surrounding Wayne County is just 5.5% — meaning Detroiters living in poverty, with a dysfunctional transit system that makes it harder to reach good-paying jobs, won't qualify for that exemption. The same is true in Flint and the state's other struggling cities.

This morning I was contacted on Twitter by a woman in Louisville, Kentucky who appears to be in pretty dire straits:

On 7/1/18, in Ky, my Medicaid/ ACA will be canceled. I may still need a brain shunt, LP #8, RXs, PT, etc. I was informed that my PCP could write a letter stating I was "Medically Fragile" but even then the provider has final say. Like fox guarding hen house. Please help me/DM

Here's her story according to her GoFundMe page (I've cleaned up the formatting a bit for easier readability):

I am a disabled attorney living with my 76-year-old mother who takes care of me. In 2011, I was bitten by a tick and was infected with Ehrlichiosis Chaffeensis and Rickettsia. A week later, I contracted Coxsackie B4 virus. Because I was kept on antibiotics for 19 years, I had no immune system to fight these illnesses.

 

From the Cabinet Meeting scene in the comedy "Dave":

DAVE: Now the Commerce Department..,

SECRETARY OF COMMERCE (sitting erect): Yes, Mr. President?

DAVE (from a card): You're spending forty-seven million dollars on an ad campaign to... (reading) 'Boost consumer confidence in the American auto industry.'

SECRETARY OF COMMERCE: Um...yes, sir...it's designed to bolster individual confidence in a previous domestic automotive purchase.

DAVE: So we're spending forty-seven million dollars so someone can feel better about a car they've already bought?

SECRETARY OF COMMERCE: Yes, sir, but I wouldn't characterize it that way...

DAVE (indignant): Well I'm sure that's really important, but I don't want to tell some eight- year-old kid he's got to sleep in the street because we want people to feel better about their cars. (beat) Do you want to tell him that?

SECRETARY OF COMMERCE (quietly): No sir...(looks at TV cameras)...no sir, I sure don't.

Except he's not threatening to shoot a dog; he's threatening the lives of nearly half a million of his constituents.

Bevin issues ultimatum: If courts block Medicaid plan, half million Kentuckians will lose care

Gov. Matt Bevin has issued an executive order that would strip Medicaid coverage from nearly half a million Kentuckians should his proposed overhaul of the federal-state health plan be struck down in court.

No one has filed a legal challenge to Bevin's changes to Kentucky's Medicaid program that federal authorities approved Friday.

But several advocacy groups have said some of the changes — such as requiring some "able-bodied" adults to work or volunteer at least 20 hours a week — likely will be challenged in court because they violate federal law that establishes Medicaid purely as a health program and does not authorize work requirements.

*UPDATE: Some have accused me of hyperbole in the headline because a) it's a "state-approved health or financial literacy" course, not a "can you read" test and b) because it would only be required if they're unable to meet the requirements in other ways. I guess I can see their point, but it strikes me as splitting hairs:

First, "literacy course" was their wording, not mine (I guess there's a distinction between "completeing a course" and "passing a test"?).

Second, there doesn't appear to be any real description of the "courses" in question--how long it is, what the criteria for measuring "completion" is, who would be conducting the course, whether you'd have to attend classes in person (vs doing so online?), how many sessions there'd be and so forth. Here's the description as laid out in the waiver request itself:

When I ran the requested rate hike numbers for Kentucky in early August, it looked like the only 2 carriers participating in the individual market next year (CareSource and Anthem BCBS) were asking for pretty hefty hikes of around 30.8% on average...and that assumed CSR reimbursement payments would be made next year. If they aren't, based on the Kaiser Family Foundation's estimates, I tacked on an additional 13.8% for a requested average of 44.3%. Ouch.

Since then, the Kentucky DOI has posted the approved rates...and the final numbers aren't not too far off, I'm afraid to say:

A week ago, Vox's Sarah Kliff reported that the Trump Administration was slashing the 2018 Open Enrollment Period advertising budget by 90% and the navigator/outreach grant budget by nearly 40%. As I noted at the time, the potential negative impact of these moves on enrollment numbers this fall--coming on top of the period being slashed in half, the CSR reimbursement and mandate enforcement sabotage efforts of the Trump/Price HHS Dept. and the general confusion and uncertainty being felt by the GOP spending the past 7 months desperately attempting to repeal the ACA altogether could be significant. In states utilizing the federal exchange (HealthCare.Gov), 2017 enrollment was running neck & neck with 2016 right up until the critical final week...which played out under the Trump Administration, which killed off the final ad/marketing blitz.

Result? A 5.3% total enrollment drop (or 4.7% if you don't include Louisiana, which expanded Medicaid halfway through the year) via HC.gov, while the 12 state-based exchanges--which run their own marketing/advertising budgets--saw a 1.8% increase in total enrollment year over year.

Yesterday saw two ugly setbacks for the ACA in Virginia and Kentucky. First, Optima announced that they were pulling out of about half the counties in the state and is resubmitting much higher rates for the other half, in large part due to the failure of the Trump Administration and the GOP Congress to commit to making CSR reimbursement payments next year. This also leaves 63 Virginia counties in jeopardy of "going bare" without any individual market carriers whatsoever.

At the same time, Anthem Health Plans of Kentucky announced that they, too, are dropping out of half of that state...once again pinning much of the blame on the CSR issue specifically:

Anthem on Wednesday continued reducing its Obamacare business, as the big insurer said it will cut in half the number of counties in Kentucky where it sells individual health plans next year.

Louise Norris gave me a heads up that the Kentucky Insurance Dept. has posted their 2018 rate hike filings as well. The individual market is pretty straightforward...and pretty grim: Both individual market carriers, CareSource and Anthem, are asking for pretty steep rate hikes even if CSR payments are locked in next year, averaging around 30.8%, while assuming another 13.5 points on top of that (71% of Kaiser's 19% Silver average) would bring the average up to around 44.3%. Not much else to say about this one for the moment.

Of the 31 states which have expanded Medicaid under the Affordable Care Act, only a handful issue regular monthly or weekly enrollment reports.

I noted in February that enrollment in the ACA's Medicaid expansion program had increased by around 35,000 people across just 4 states (LA, MI, MN & PA).

It's early June now, so I checked in once more, and the numbers have continued to grow. I have the direct links for 5 states now (including New Hampshire)...

 

I used to write about Kentucky quite a bit shortly after incoming GOP Governor Matt Bevin made good on his promise to disassemble their beloved and award-winning "kynect" state ACA exchange. I haven't written much about the state since then, however, until now.

Bevin made two major campaign promises while running to replace former Democratic Governor Steve Beshear (who expanded Medicaid and established kynect via executive order): He said he'd kill kynect and get rid of ACA Medicaid expansion. He stuck to his guns on the former, and while it's a damned shame that he did so for a number of reasons (it was working perfectly well, had a high public image and awareness, etc), it didn't cause too much damage, since KY simply shifted to the federal exchange instead (HealthCare.Gov). Enrollment did drop off by over 13% year over year, but a few other states saw similar drops, so the move probably wasn't a major factor.

In Kentucky, assuming 80,000 people enroll in private exchange policies by the end of January, I estimate around 43,000 of them would be forced off of their private policy upon an immediate-effect full ACA repeal, plus another 443,000 enrolled in the ACA Medicaid expansion program, for a total of 487,000 residents kicked to the curb.

As for the individual market, my standard methodology applies:

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