START OF 2018 OPEN ENROLLMENT PERIOD

Time: D H M S

Minnesota

In a year when every state's 2018 Open Enrollment situation is messy to say the least, Minnesota's is far more so:

  • Last year they were facing massive rate hikes, especially for unsubsidized enrollees (yeah, I know, I know, don't say it), and came very close to having all of their carriers bail
  • In response, they agreed to let most of them put a maximum enrollment cap on a First Come First Serve, with Blue Plus (BCBSMN) agreeing to take the "overflow".
  • However, the unsubsidized individual market enrollees were royally screwed, so the state legislature and governor slapped together a special, one-time 25% premium rebate specifically for them. The money came directly out of other portions of the state general fund, I believe. MNsure, the state exchange, also added an extra 8-day special enrollment period for these folks to jump in and get in on the rebate.

For 2017, unsubsidized enrollees on the Minnesota individual market faced massive rate hikes averaging 57%. It was so bad that the only way they could convince some carriers to participate in the market was to allow most of them to put a cap on how many people they'd enroll (with the balance being shunted over to Blue Plus, the HMO division of BCBSMN). This resulted in a massive initial surge of enrollment, as it was on a first-come, first-serve basis...but also left off-exchange and unsubsidized exchange enrollees high and dry.

In response, the state scrambled to pull together a $300 million package to help supplement premiums for those folks...knocking a flat 25% off of their premiums for 2017. This helped ease the problem in the short term, but the larger issue still loomed going forward.

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)...

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). By the end of March, the numbers in these 4 states had gone up by another 19,300.

It's the end of April now, so I checked in once more, and sure enough, the numbers continue to grow:

You may have noticed that among my 16 recommendations for repairing/improving the ACA, I foolishly failed to include one of the most important/obvious ones: Reinsurance. I didn't include it for two reasons: Partly because, quite frankly, I simply forgot about it and feel bad about myself now.

So far, two states (Alaska and Minnesota) have already established their own state-based reinsurance programs; in both cases, it was done as an act of sheer desperation...and, in both cases were put through in a bipartisan fashion (both states have GOP-held legislatures, but Minnesota's Governor is Democratic while Alaska's is Independent):

Alaska: Approved *unsubsidized* 2017 indy mkt rate hikes: 7.3%

There was a time, just a few months ago, when it looked like Alaska, which had already suffered from massive rate hikes the past 2 years due to their unique healthcare situation, might have a complete catastrophe on their hands with a third year of massive individual market rate hikes.

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

Back on February 28th I noted that ACA Medicaid expansion enrollment across three states (Michigan, Louisiana and Pennsylvania) had grown by about 35,000 people since mid-January, to 667K, 406K and 716K people respectively.

Today, a month later, I decided to take another look at all three states, along with Minnesota (which I forgot to check last month). Sure enough, enrollment has continued to grow in all four, albeit at a slower pace:

NOTE: I have to attend a field trip with my kid this morning so won't be able to post about the Minnesota results until around noon, but here's an overview:

There are only 2 states which still haven't announced their final 2017 Open Enrollment Period totals: Vermont and Minnesota. Vermont isn't likely to have anything too noteworthy to say (I've confirmed ~29K QHPs...they'll probably top out at ~30K), but Minnesota has a very special situation.

Minnesota confirmed ~106,000 QHP selections as of January 10th, so they probably tacked on another 5K - 10K during the last 3 weeks of open enrollment, for a total of perhaps 115,000. This would be impressive already, since they only enrolled 83.5K people last year.

However, they're also wrapping up (even as I type this) an 8-day Special Enrollment Period piggybacked onto the end of January, and those who enroll during this SEP could receive a 25% discount on their premiums depending on their income. Here's the backstory.

Last week I posted an exclusive story over at healthinsurance.org regarding attempts by the Minnesota Republican-held legislature to sneak in a nasty amendment which, had it passed and been signed into law, would have given insurance carriers the right to offer policies which cover, basically nothing whatsoever.

The story ended on a happy note a few days later, as the massive negative backlash caused the state GOP to yank the amendment from the bill in question just before it went to the final vote. Awesome!!

However, I never really explained exactly what bill the pulled amendment was attached to in the first place. I should have written up a full entry on this, but have been swamped all week due to the political insanity and rapidly-changing situation on everything, so here's the basics:

 

UPDATE 3/14/17: Dammit, I was afraid of this...

via Lindsey Port (who ran for MN State House last fall):

It's Back!  Okay, folks, it's time to call your legislators, because the Drazkowski bill is back, and the GOP is giving it a full hearing TODAY!

This is the bill that would allow insurance companies to sell policies that do not cover chemotherapy, diabetes treatments, mental health services, maternity care, and many more benefits that are currently required to be covered by MN law.

The photo included is the Minnesota Statute 62Q, which is the statute that is being amended with this bill. These are the services that would be allowed to no longer be covered.

I've decided that for all future ACA enrollment data reports, I'm going to tack on "...on brink of possible ACA repeal" to the headline. Seems appropriate.

It's been quite awhile since I've written much of anything about the ACA's SHOP programs, which are the small business counterpart to the individual/family exchanges. The reason is pretty simple: SHOP enrollment is mostly a rounding error compared to either the ACA's Individual exchange enrollments or Medicaid expansion numbers.

SHOP enrollment (a mere 120K - 170K nationally, as far as I can tell) is even dwarfed by BHP program enrollment (around 700,000)...and that's only available in 2 states (Minnesota and New York). Heck, I don't even bother tracking them on my spreadsheets or graphs (I tried in 2014 but gave up on it the following year).

Still, once in awhile there's a bit of SHOP news to report, and this press release out of Minnesota is such an occasion:

In Minnesota, assuming 116,000 people enroll in private exchange policies by the end of January, I estimate around 58,000 of them would be forced off of their private policy upon an immediate-effect full ACA repeal, plus another 234,000 enrolled in the ACA Medicaid expansion program and around 62,000 covered by their Basic Health Plan (BHP) program (aka MinnesotaCare) for a total of 354,000 residents kicked to the curb.

As for the individual market, my standard methodology applies:

A few days ago I noted that MNsure, Minnesota's ACA exchange, has skyrocketed from last place to first in terms of achieving my personal OE4 enrollment targets, having enrolled 103,578 people in Qualified Health Plans (QHPs), plus another 19,960 in MinnesotaCare (MN's BHP program) and 65,164 in Medicaid.

Yestrerday they updated their numbers once again:

That's a further increase of 3,009 Minnesotans in QHPs in the past week or so. MN has already blown past my original projection (86K) and has reached 92% of my revised target (116K).

Whoops! I think I owe the folks at MNsure a bit of an apology. A week or so ago I stated:

Minnesota is a different story. They started out Open Enrollment with a bang, racking up enrollees at up to 12x last year's pace...but that was mainly due to their unique "enrollment cap" policy this year. Once the caps were filled and current enrollees were all squared away, new enrollments appear to have dropped off dramatically. They're now dead last percent-of-target wise (again, I can't include NY or VT here since neither has enough data available).

This Just In...(Minnesota was one of the few states which stuck with the original 12/15 deadline for January coverage):

ST. PAUL, Minn.— MNsure has enrolled 54,586 Minnesotans in private health care coverage, far outpacing the approximately 27,000 who had enrolled at a similar stage of open enrollment last year.

Additionally, since the start of open enrollment, 14,020 Minnesotans have eligibility determinations in MinnesotaCare and 43,327 in Medical Assistance.

The 2015-2016 open enrollment period set a record for the most Minnesotans enrolled in private health plans, but the 2016-2017 period has been even more brisk. By December 28, 2015, the deadline for January 1 enrollment last year, about 27,000 had enrolled, meaning enrollment numbers are twice what they were at the same time last year.

Just a couple of days ago, MNsure reported 41,882 QHP selections as of December 11th (there was some confusion about the date but I've since confirmed this).

Today, just a day and a half before the deadline for January coverge, they've posted another update:

That's 2,395 more QHP selections in the past 2 days.

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