Maryland

2019 OPEN ENROLLMENT ENDS (most states)

Time: D H M S

Last spring, both New Jersey and Maryland were among the states which were the most pro-active about passing lesiglation to cancel out Donald Trump's attempts to deliberately sabotage the Affordable Care Act. Both states passed laws cracking down on non-ACA compliant short-term and association health plans (NJ actually already didn't allow short-term plans before the ACA anyway), both states established robust reinsurance programs, and both states tried to pass bills reinstating the ACA's Individual Mandate Penalty which Congressional Republicans repealed last winter in different ways.

New Jersey was successful: They kept their mandate penalty restoration bill pretty much identical to the version repealed at the federal level and plan on using the revenue from it to help pay for the reinsurance program. The combined impact of all of their anti-sabotage efforts led to roughly a $1,500 annual premium savings for every unsubsidized individual market enrollee in the state.

When Maryland insurance carriers originally submitted their proposed 2019 premium changes back in May, it looked pretty grim...they were expected to average around 29.5% statewide for the ACA-compliant individual market., increasing from around $631/month on average to roughly $817/month for unsubsidized enrollees.

Thanks to swift, bipartisan action on the part of the Democratically-controlled Maryland state legislature and the Republican Governor, Maryland was able to pass several bills which partially negated or cancelled out Trump/Congressional Republican sabotage of the Affordable Care Act. In particular, they passed laws which locked in current restrictions on both short-term plans and association health plans (the types of "junk policies" which Trump is pushing hard to expand upon)...along with an extremely robust reinsurance program.

 

via Nicholas Bagley of The Incidental Economist:

Maryland files suit to protect health reform from Texas.

... the Maryland attorney general today filed a separate lawsuit in a Maryland district court. Among other things, he’s seeking an injunction requiring the continued enforcement of the law. Depending on how quickly the Maryland case moves, it’s possible we could see dueling injunctions—one ordering the Trump administration to stop enforcing the law, the other ordering it to keep enforcing.

That’s an unholy mess just waiting to happen. Now, it may not come to that. My best guess is that the Texas lawsuit will fizzle: any injunction will likely be stayed pending appeal, either by the Fifth Circuit or the Supreme Court, and the case is going nowhere on the merits. The Maryland lawsuit will likely prove unnecessary.

I don't have much to add to this other than to note how much this case underscores just how much power and importance state attorneys general have.

CMS Administrator Seema Verma is difficult to get a read on. On the one hand, she glories in trashing the ACA every chance she gets while happily endorsing nearly every effort to undermine or sabotage it, including repeal of the individual mandate, slashing the marketing and outreach budgets and so forth. Last year she was even busted trying to (effectively) blackmail the insurance carriers at large by offering to push through CSR reimbursement payment in return for them supporting the GOP's Obamacare repeal bill.

At the same time, she--like Trump's first HHS Secretary, Tom Price--also seems to have a soft spot for one particular type of ACA improvement program: Reinsurance.

I admit to not knowing a whole lot about how Maryland's "All-Payer" system works aside from every payer (Medicare, Medicaid, private insurance) having to pay the same amount for the same services at a given hospital. Here's a general summary from Wikipedia:

All-payer rate setting is a price setting mechanism in which all third parties pay the same price for services at a given hospital. The system does not imply that charges are the same for every hospital. It can be used to increase the market power of payers (such as private and/or public insurance companies) to mitigate inflation in health care costs. All-payer characteristics are found in the health systems of France, Germany, Japan, and the Netherlands. Maryland also uses such a model.

Hot on the heels of Virginia, Maryland is the 2nd state to post their preliminary 2019 unsubsidized ACA policy rate increase requests. According to Paul Demko of Politico...

Insurers selling Obamacare plans in Maryland are again seeking huge rate increases for 2019, but they could be knocked down significantly by a reinsurance program the state hopes to implement for next year.

CareFirst BlueCross BlueShield wants to increase rates on average by 18.5 percent on its HMO plans, which account for more than half of the individual market this year. Kaiser Permanente, the only other insurer selling on the exchange, is seeking a 37.4 percent average increase on its HMO plans, which cover just over a third of Obamacare customers.

A few days ago I noted that Maryland Governor Larry Hogan had signed a bipartisan bill into law which creates a $380 million reinsurance fund which should cancel out up to 21% of next year's looming individual market premium hikes.

However, I forgot to mention the other important thing that the same bill does: Evidently it would also head off Donald Trump's attempt to open the floodgates on the type of minimally-regulated "short-term" and "association" plans which would further damage the ACA-compliant individual market risk pool:

(C) THIS SUBTITLE APPLIES TO ANY HEALTH BENEFIT PLAN OFFERED BY AN ASSOCIATION, A PROFESSIONAL EMPLOYEE ORGANIZATION, OR ANY OTHER ENTITY, INCLUDING A PLAN ISSUED UNDER THE LAWS OF ANOTHER STATE, IF THE HEALTH BENEFIT PLAN COVERS ELIGIBLE EMPLOYEES OF ONE OR MORE SMALL EMPLOYERS AND MEETS THE REQUIREMENTS OF SUBSECTION (A) OF THIS SECTION.

Maryland Governor Larry Hogan signed a bipartisan bill on Thursday that state officials say will help keep healthcare premiums from spiking again next year.

The bill creates what’s known as a reinsurance program for the state’s health insurance marketplace, which was created as part of the Affordable Care Act.

...Without the fix or any action in Washington, Maryland officials predicted that healthcare premiums in 2019 could jump up to 50 percent, driving more of the 150,000 people to abandon the state’s marketplace — possibly leading to its collapse.

I just did a light analysis of how many people would be helped or hurt by CSR funding in 2019 in Rhode Island, and concluded that at least 28% of exchange enrollees would see their premiums increase if CSR funding was restored, while only perhaps 2-3% would see their premiums drop.

It turns out that over the weekend, my colleague Xpostfactoid did a much deeper analysis of the same situation in Maryland:

So there you have the enrollment results of full-bore on-exchange silver-loading of CSR costs in one state. In all, 49,993 on-exchange enrollees with incomes up to 400% FPL chose plans other than silver. About 48,000 of them were subsidized. That's 31.2% of all enrollees, within striking distance of Aron-Dine's upper bound of 36% for all marketplace enrollees.

Now that the 2018 Open Enrollment period is officially over in every state +DC, I've started compiling more detailed demographic breakouts of the data on a state-by-state basis. The official CMS report from the Assistant Secretary for Planning & Evaluation (ASPE) report should be released at some point in the next couple of weeks, but until then, I'll have to settle for whatever reports I can patch together from some of the state-based exchanges.

So far I've dug up final (or near final) data for six states: Colorado, Connecticut, Idaho, Maryland, Minnesota and Washington State. Collectively, these states only represent about 890,000 2018 exchange enrollees, or roughly 7.5% of the 11.8 million total, so I have no idea how representative they are nationally, but it's all I have to work with for the moment.

The type of demographic data available varies greatly from state to state, but a major data point available from all six of them also happens to be one of the more interesting points, especially this year, given the " CSR Silver Loading" gambit available in most states this year.

Maryland was originally one of 3 state-based exchanges which stuck to the "official" half-length, December 15th Open Enrollment Period deadline this time around. However, with just 2 days to go before the original deadline, the MD Health Connection announced that they had decided to bump out their deadline by an extra week after all, through December 22nd.

When the dust settled, 153,571 Marylanders had signed up for 2018 coverage, down about 2.7% from 2017. This made MD one of only three fully state-based exchanges to come in short year over year...and the only one to do so with an extended deadline (both Idaho and Vermont stuck with the 12/15 cut-off). Even so, achieving over 97% of their prior-year numbers is still pretty impressive, all things considered.

This just in...

NEARLY 154,000 MARYLANDERS ENROLLED IN MARKETPLACE HEALTH COVERAGE FOR 2018

BALTIMORE (JAN. 4, 2018) – A total of 153,571 Marylanders enrolled in private health coverage during the 2018 open enrollment for Maryland Health Connection, the state-based health insurance marketplace.

In an open enrollment period that was about half as long as a year ago, average daily enrollment in qualified health plans was up 69 percent compared to the prior open enrollment. There were an average of 2,953 enrollments each day during the recent 52-day period, compared to 1,752 average daily enrollments during a 90-day enrollment period a year ago.

“We are thrilled by the robust turnout for 2018 coverage,” said Michele Eberle, executive director of the Maryland Health Benefit Exchange, which administers Maryland Health Connection. “Our hats are off to our call center, consumer assisters and brokers who helped process roughly as many enrollments as last year during a much shorter open enrollment period. We believe the result will be better access and better health outcomes for Maryland families.”

I've been expecting the first and third of these developments:

MARYLAND Open enrollment extended by one week:

OPEN ENROLLMENT EXTENDED UNTIL DEC. 22
ONE WEEK ADDED TO ENROLL IN 2018 HEALTH, DENTAL COVERAGE

BALTIMORE (DEC. 13, 2017) – Open enrollment through Maryland Health Connection has been extended until Friday, Dec. 22 to choose a plan for health coverage to begin Jan. 1, 2018, with expanded call center hours through next week.

Individuals can apply at MarylandHealthConnection.gov or through the “Enroll MHC” mobile app available free in the App Store (iOS) and the Google Play Store (Android).

Also, hundreds of insurance brokers and navigators around the state can help Marylanders apply for financial help and enroll in a plan. Their locations and contact information are available at MarylandHealthConnection.gov or through a GPS-enabled locator tool on the app.

The last update out of Maryland had 2018 QHP selections breaking 130K total, with new enrollments up 10% and overall enrollments up 3% year over year through Nov. 17th.

Just now, the MD Health Connection posted an update through this week:

Incoming exec director Michele Eberle of @MarylandConnect urges Marylanders to enroll in health coverage with 10 days left. New enrollments up 14% this year. Mobile app visitors up 140% Overall enrollment up 4% Keep it going! pic.twitter.com/75g2qu5PbC

— MD Health Connection (@MarylandConnect) December 5, 2017

I'm assuming these stats are as of December 4th. Last year MD's official QHP selection tally as of December 3rd was around 129,000; if they're 4% ahead of that as of the same date, that means they should have a little over 134,000 to date this year.

via the Maryland Health Connection:

MARYLAND ACA EXCHANGE ENROLLMENTS AS OF 11/17/17:

  • Total Enrollments (active renewal, passive renewal, new): 130,556 (up 3% vs. last year)
  • Active Enrollments (renewals + new): 29,478 (up 98% over last year)
  • New Enrollments: 10,900 (up 10% over last year)
  • Applications: 275,790 (up 13% over last year)
  • Mobile App Visitors: 74,744 (up 110% over last year)

OK, the MD exchange breaks out their numbers slightly differently than I do, but they've provided the numbers necessary to reformat. Like a few other states, they're "front-loading" their auto-renewals, giving the following:

  • 18,578 Active Renewals
  • 101,078 Auto-Renewals
  • 10,900 NEW Enrollees
  • 130,556 TOTAL Enrollments

For clarification: When the MD exchange says that 130,556 is "3% higher than last year", they're talking about at this point in time. Subtract 3% and you get roughly 126.7K as of 11/17/16. Maryland's total enrollment by the end of the 2017 Open Enrollment Period was 157,832.

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