In 2015, Republican Matt Bevin campaigned for governor on two major healthcare-related platforms:
Eliminate the state's perfectly-functioning, award-winning, highly-praised and beloved ACA exchange, "kynect" for no particular reason other than spite.
Eliminate the state's ACA Medicaid expansion program, which as of this writing provides around 480,000 low-income Kentuckians with healthcare coverage.
For some inexplicable reason, voters in Kentucky elected him regardless. Once he got into office, he did indeed make good on the first promise, shutting down the state's perfectly good ACA exchange platform and shifting KY to the federal exchange at HealthCare.Gov.
When it came to eliminating Medicaid expansion, on the other hand, he found it to be a little bit tougher than expected; actually pulling the plug on nearly half a million people's healthcare coverage proved to be a tougher nut to crack than he thought.
As I've noted several times recently, the "break off of HealthCare.Gov & establish your own state-based ACA exchange" train continues to pick up steam, with the following states having committed to either firing up their own, separate exchange website platform or at the very least going halfway by establishing their own exchange entity (which includes a board of directors, their own marketing/outreach budget, the ability to dictate which plans are allowed onto the exchange and so forth) if they haven't already done so.
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:
Proposed Insurance Rates Submitted to DOI for Review
Rates Subject to Review
Frankfort, Ky. (June 25, 2019) – Insurance Carriers have submitted proposed rates to the Department of Insurance (DOI) for Kentucky’s 2020 individual and small group markets. Anthem Health Plans of Kentucky, Inc. (Anthem) filed requests for 13 different plans to be offered on the Exchange with a proposed average rate increase of 12%.CareSource Kentucky Co. requested an average rate decrease of 4.5% for 12 different plans to be offered on the Exchange. This decrease follows the 19.4% rate increase approved last year for the 12 plans it offered. The submitted rates are subject to review by the Department.
Last week I noted that Pennsylvania is joining Nevada, New Mexico, New Jersey and (apparently) Oregon in moving away from the federal ACA exchange mothership known as HealthCare.Gov:
Pennsylvania moves to take over health insurance exchange
Pennsylvania is moving to take over the online health insurance exchange that’s been operated by the federal government since 2014, saying it can cut health insurance costs for the hundreds of thousands who buy the individual Affordable Care Act policies.
...The bill is backed by Gov. Tom Wolf, a Democrat, and his administration says it would make two important changes to reduce premiums for the 400,000 people who purchase health insurance through the Healthcare.gov online marketplace.
Last year, Republican Governor of Kentucky Matt Bevin, who had campaigned heavily on a promise to repeal ACA Medicaid expansion altogether, partly changed his tune once he actually took office. Instead of kicking all 450,000 low-income Kentucky residents off the program completely, he first imposed an absurdly insulting and cumbersome "frequent flyer"-style program:
Kentucky is moving closer to an overhaul of the state's Medicaid program Bevin has said is aimed at controlling costs and encouraging more personal responsibility in consumers, changes that include elimination of basic dental and vision benefits for most "able-bodied" adults who instead would have to earn them through a "rewards" program.
..."It is expensive to go to a dentist," he said. "These changes are just ludicrous."
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.
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).
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.
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
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.