START OF 2018 OPEN ENROLLMENT PERIOD

Time: D H M S

New Jersey

When I plugged in the requested rate hike numbers for New Jersey back in August, they averaged around 8.5% assuming CSR payments would be made, or around 21.6% if they aren't.

The approved rate increases for NJ were just released, and the numbers appear to be pretty close to that, if a bit higher: 9.9% and 22.0% respectively.

Truth be told, I only have the hard numbers for the exchange-based carriers...and even those aren't technically official; they come from this NJ.com article:

TRENTON -- New Jersey residents who bought their own health coverage from Horizon Blue Cross Blue Shield through the Affordable Care Act could pay an average of 24 percent more next year, according to state-approved rates released on Tuesday.

Horizon is one of three insurance companies in New Jersey participating in the Obamacare marketplace in 2018. But it is the most dominant, insuring 72 percent of the 244,000 individual policy holders this year.

I had already posted a partial look at the New Jersey rate hike situation a couple of weeks ago with a video in which Topher Spiro of the Center for American Progress interviewed NJ Congressman Frank Pallone about the situation. Since his comments weren't official and only referred to Horizon Blue Cross, I didn't make it an official part of the Rate Hike spreadsheet, but now I've managed to plug in the remaining carriers and here's how it looks. As expected, with Horizon holding a commanding 70% market share, the statewide average is around 8.5% if CSR payments are made and the mandate is enforced versus 21.6% if CSR payments aren't made and the mandate isn't enforced.

Also, check out Horizon's cover letter explaining the rate hike...they're not screwing around with who to pin the blame on.

 

Thanks to Emily Gee and the Center for American Progress for this:

This isn't a full/official New Jersey rate hike update, as it only refers to one carrier, and rounds things off a bit, but in the video above, if you watch from around 37:30 to 41:00, you'll hear New Jersey Congressman Frank Pallone talk about the negative impact that the CSR reimbursement threat/uncertainty/sabotage effect is having on Horizon Blue Cross Blue Shield...and since Horizon BCBS happens to hold something like 70% of the New Jersey individual market share (which is confirmed by Pallone in the video), the statewide weighted average rate hike will end up being largely determined by theirs.

The most relevant part:

"So Horizon, which is something like 70% of our market in New Jersey, filed like a 24% increase. And I asked the president (of Horizon) "why are you filing with a 24% increase?" I can't imagine that health insurance costs have gone up that much. And he said "Oh, they haven't, Congressman." I said, "well, what is this?"

Assuming 310,000 people enroll in private exchange policies by the end of January, I estimate around 207,000 of them would be forced off of their private policy upon an immediate-effect full ACA repeal, plus another 532,000 enrolled in the ACA Medicaid expansion program, for a total of 739,000 New Jersey residents kicked to the curb.

Thanks to Louise Norris for providing this report which breaks out the Medicaid expansion numbers by county. It's worth noting that like New York, New Jersey will also see more people lose Medicaid coverage post-ACA repeal than technically signed up "because" of the law because they, too, had previously partly expanded Medicaid via a pre-ACA waiver which has since expired. Unlike New York, however, in New Jersey's case I had already baked the larger number into my estimates anyway, so it hasn't changed anything.

As for the individual market, my standard methodology applies:

Last week I noted that with 41 states accounted for and the 2017 Open Enrollment Period quickly bearing down on everyone, it was time to pull the plug on my 2017 Average Rate Hike project and move on. I had come up with an overall national weighted unsubsidized average rate increase of around 25% for ACA-compliant individual market plans.

However, I also noted that I'd make sure to fill in the approved rates for the remaining 10 states as they came in, for completeness sake...and today, thanks to the HHS Dept. cutting the ribbon on 2017 Window Shopping at HealthCare.Gov, I've also been able to fill in the blanks for five of the remaining states all in one shot (the other five remain elusive).

I have very few details on this one,

The great @katiedjennings reports NJ is ordering Health Republic of NJ to cease plan offerings in 2017. cc: @khemp64 @pauldemko

— Dan Goldberg (@DanCGoldberg) September 12, 2016

@charles_gaba @DanCGoldberg @khemp64 @pauldemko they lost $59M in first 6 months of the year

— Katie Jennings (@katiedjennings) September 13, 2016

Her story is buried behind a firewall at POLITICO Pro, but I do have some crucial info:

Over the past few days I've been doing some serious number-crunching in an attempt to break out the entire individual market between exchange-based, ACA-compliant off-exchange, grandfathered and transitional plans. For the most part, I believe most of my data is pretty close...but there's still some pieces of the puzzle missing here and there.

For New Jersey, my current numbers (as of March 2016) are:

Thanks again to commenter "M E" for finding this Business Insider article in which health insurance startup Oscar Insurance Co. has announced that they're pulling out of the ACA exchange completely in New Jersey, and out of the Dallas market specifically in Texas...while also expanding into San Francisco next year:

According to a release from the company on Tuesday, the firm will no longer offer individual market plans through the Affordable Care Act in Dallas, Texas, and New Jersey.

..."We hope to return to these markets as we carry on with our mission to change healthcare in the US."

The "we hope to return" part suggests that Oscar will continue to be available off the exchange in New Jersey, since completely pulling out of a state means a carrier has to wait at least 5 years before re-entering. So...there's that, anyway.

...Oscar currently covers 7,000 people in Dallas and 26,000 in New Jersey.

As I noted Monday, I believe 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.

In 2014, New Jersey's total individual market was estimated at around 261,000 people, including off-exchange, grandfathered and transitional enrollees. Assuming 25% growth, this should be around 325,000 today.

After a couple of quiet weeks, I have to dust off the UnitedHealthcare Dropout Odometer again. According to Katie Jennings of Politico...

UnitedHealth Group is pulling out of New Jersey’s Obamacare marketplace in 2017.

The company’s subsidiary, Oxford Health Plans, will stop offering individual plans on the state’s federally facilitated health insurance marketplace, according to a letter from the state Department of Banking and Insurance.

The letter was obtained by POLITICO through an Open Public Records Act request and the company later confirmed it will not offer exchange plans next year.

“Individuals impacted by these decisions will continue to have access to their current health benefits until the end of 2016, when they will need to pick new plans for 2017. Our small and large group business, Medicare and Medicaid businesses will not be impacted by this decision,” the company said in an emailed statement.

This may seem like common knowledge now, but in 2014, it felt like I was one of the only people who recognized that there were millions of people enrolling in ACA-compliant policies off of the ACA exchanges, directly via the insurance carriers themselves. My best estimate for 2014 was that in addition to the 7 million or so exchange-based individual market enrollees, there were another roughly 8 million people who enrolled off-exchange (although several million of those were in non-ACA compliant policies).

IMPORTANT: See this detailed explanation of how I've come up with the following estimated maximum weighted average rate increase request for New Jersey

Assuming you've read through the explanation linked to above, here's my best estimate of the maximum possible and most likely average rate increase requests for the New Jersey individual market:

Again, the full explanation is included in the Missouri estimate, but to the best of my knowledge, it looks like the companies requesting rate increases higher than 10% come in at a weighted 13.4% increase, but only make up about 50% of the total ACA-compliant individual market, with several other companies (Oscar, AmeriHealth & possibly other off-exchange only companies) requesting increases of less than 10% (or possibly even decreases in some cases) and making up the other half.

This article is mainly about New Jersey ACA navigators strategizing for the 2016 open enrollment period, but it also includes one handy data nugget:

In addition, NJ FamilyCare – the state’s primary Medicaid coverage program -- has added 463,463 residents to its rolls since December 2013, including 42,947 in April.

The fact that 9% of the net increase happend 16 months after the Medicaid expansion provision started is surprising to me, consideirng that according to the Kaiser Family Foundation, only around 390,000 uninsured NJ residents were even eligible for the program as of last fall to begin with. In other states, like Michigan, things have pretty much plateaued as every eligible resident has pretty much been enrolled already.

When I last checked in on New Jersey back in June, their Obamacare Medicaid expansion tally was at around 229,000 people. This number has jumped to 343,000, out of around 466,000 NJ residents eligible for the program, or roughly 74%:

The 343,000-person expansion in Medicaid enrollment this year is nearly three quarters of the 466,000-person expansion-eligible population estimate by the Kaiser Family Foundation. But the 161,775 residents who enrolled through the marketplace are equal to just over one quarter of the estimated 628,000 eligible.

The other noteworthy thing here is that according to my own breakdown of the KFF estimates, New Jersey only has around 562,000 uninsured eligible for tax credits via the ACA, not 628K. However, this is mostly moot since those with insurance can also purchase QHPs via the exchange as well if they wish, so it's not really that big of a deal.

As for the 161,775 QHP figure, that dates back to last spring, so no update there.

Last October, at the height of the botched HC.gov rollout, I repeatedly commented over at Daily Kos:

 I still don't know why they didn't roll it out one state per day; if they'd gone alphabetically, they would have had a solid week to work the kinks out with a (relatively) low volume before hitting a big state:

  • Alabama, Alaska, Arizona and Arkansas are all relatively low-population.
  • California, Colorado, Connecticut and Delaware* are all state-run exchanges.
  • That means they wouldn't have hit Florida on the federal site until tomorrow.

I know that the system still would have had serious software issues, but at least they wouldn't have to deal with the massive overload of traffic at the same time that they were trying to fix the issues.

*(Obviously I was mistaken at the time about Delaware running their own exchange, but it's still a low-population state so my point was still valid...and of course the District of Columbia does run their own exchange).

Well, obviously it was too late for that at the time, and they've since scrambled to get their act together on the individual exchange side.

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