Ohio

After writing about the newly-signed laws in Georgia and Ohio banning virtually all abortions after 6 weeks (when most women don't even know they're pregnant), even in most cases of rape, incest of the health of the mother, I didn't think that a story about abortion-related legislation could get more horrific and insane.

I was wrong:

A new Ohio bill would ban most private insurance coverage for abortions. Opponents say it would also ban effective methods of birth control.

One-fifth of representatives in the House, all Republicans, have signed onto House Bill 182 sponsored by state Rep. John Becker (R-Union Twp.) that would prohibit most insurance companies from offering coverage for abortion services.

“The intent is to save lives and reduce the cost of employers and employees health care insurance," Becker says.

The tagline for ACASignups.net is "healthcare policy data, analysis & snark", so naturally many of my blog posts have tongue-in-cheek, sarcastic headlines.

This is not one of those times. The headline above is absolutely, sickeningly true.

On a couple of days ago, both houses of the Ohio state legislature--the House and Senate alike--voted to ban abortion outright six weeks after conception. There's no exception for rape. There's no exception for incest. There is an exception for the life of the mother (not her health, mind you...just her actual ability to keep breathing)...but that's it. Yesterday this bill was signed into law by GOP Governor Mike DeWine.

The six-week abortion ban known as the "heartbeat bill" is now law in Ohio. That makes Ohio the sixth state in the nation to attempt to outlaw abortions at the point a fetal heartbeat can be detected.

Ugh:

CMS gives thumbs-up to Medicaid work requirements in Ohio

The Centers for Medicare & Medicaid Services has approved a waiver request for work requirements in Ohio’s Medicaid program.

...CMS rolled out guidance on these waivers in January 2018, and since then eight states, including Ohio, have had requests approved. Several additional states have submitted waivers that the agency has yet to weigh in on.

...Arkansas is the only state where such work requirements have formally been launched, and in the last several months of 2018, more than 18,000 people lost Medicaid coverage as a result of the work requirement. The Kaiser Family Foundation estimated that most of these losses were a result of the administrative requirements associated with reporting work hours.

Double Ugh:

Last week I noted that New Mexico had capped off a flurry of positive healthcare policy legislation by passing a bill (in dramatic fashion) which would lock in ACA-level protections for those with pre-existing conditions in the event the ACA itself is ever repealed or weakened.

Once this bill is signed by the Governor (which is almost certain to happen), New Mexico will join four other states (Massachusetts, New York, Colorado and Virginia) in fully protecting all three types of "blue leg" protections: Guaranteed Issue, Community Rating and Essential Health Benefits. The New Mexico bill also locks in a fourth ACA protection: The prohibition on annual or lifetime coverage limits.

As I noted back in June, the Ohio Insurance Dept. doesn't seem to like providing a whole lot of detail about their insurance rate filings on their website; at the time, they only stated the following regarding the preliminary 2019 individual market rate filings:

In 2018, 8 companies sold health insurance products on the exchange in Ohio and 42 counties had just one insurer with an additional 20 counties having only two.

For 2019, 10 companies have filed rates and forms for the Department to review and all 88 counties will have at least one insurer. Preliminary filings show 16 counties with just one insurer and 33 counties with two.

Hmmm...extremely thin detail here, but I'll take what I can get for the moment:

Ohio Health Insurance Exchange 2019

The Affordable Care Act (ACA) requires that every state have an exchange where consumers can buy individual health insurance policies. In Ohio, the federal government runs the health insurance exchange. Ohioans who do not have health insurance through their employer, Medicare or Medicaid may be eligible to purchase coverage through the exchange. Open enrollment for coverage next year (2019) begins November 1, 2018. Below is preliminary data based on the filings submissions of insurers in Ohio. Once filings are approved in late summer/early fall, final information will be posted.

Ohio’s Health Insurance Market (2018–2019)

In 2018, 8 companies sold health insurance products on the exchange in Ohio and 42 counties had just one insurer with an additional 20 counties having only two.

Protect Our Care is a healthcare advocacy coalition created last December to help fight back against the GOP's attempts to repeal, sabotage and otherwise undermine the Affordable Care Act. This morning they released a report which compiled the approved 2018 individual market rate increases across over two dozen states.

Needless to say, they found that the vast majority of the state insurance regulators and/or carriers themselves are pinning a large chunk (and in some cases, nearly all) of the rate hikes for next year specifically on Trump administration sabotage efforts...primarily uncertainty over CSR payment reimbursements and, to a lesser extent, uncertainty over enforcement of the individual mandate penalty.

Like Wisconsin and Michigan, Ohio has a high number of carriers statewide...although the per-county competition is still lacking in some areas. Even so, their rate hike requests are still pretty high even with CSR payments being made...and dramatically higher if they aren't.

One interesting tidbit: Check out the CareSource filing letter (first one below the table). They don't mention CSRs or mandate enforcement...but they do specify that a full 5 points of their 23.9% increase request is tied to prescription drug inflation (see Shkreli, Martin)...and even more noteworthy, they say that another 5 points is due specifically to "a number of previously [Medicaid-] qualified individuals" being kicked over to the private exchange, 

So, I got back from my trip to the NIHCM awards dinner in DC late last night, and am groggily attempting to bone up on all the healthcare stuff which happened while I was gone (ironic, of course, given that I was attending a healthcare-related event filled with other healthcare wonks/reporters).

In the past 2 days...

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)...

Assuming 265,000 people enroll in exchange policies by the end of January, I estimate around 175,000 of them would be forced off of their private policy upon an immediate-effect full ACA repeal, plus another 692,000 enrolled in the ACA Medicaid expansion program, for a total of over 865,000 Ohioans kicked to the curb.

As for the individual market, my standard methodology applies:

As noted before, I'm really trying to move onto the actual enrollment part of the 2017 open enrollment period, but I can't resist doing some more final cleanup of my Rate Hike project:

  • SOUTH CAROLINA: This is one of the 5 states which I still didn't have approved rate changes for. Today the RateReview.HC.gov site finally added in the final numbers for SC, so here's what it looks like:

Aetna was a bit tricky--the total enrollee number is actually 41,988. They dropped out of the ACA exchange but are sticking around the off-exchange market, so I had to figure out how many of those 42K are on vs. off-exchange. The answer is in this article which notes:

More than 220,000 South Carolinians rely on the federal health care law for insurance. This year, only 8,000 of them are covered by Aetna plans.

Here's some relatively good news! Ohio's 2017 requested rate filings have finally been published, and considering that some other states are looking at weighted average requested increases of 30%, 40% or even as high as 56%, Ohio's 13.1% average is actually refreshingly low by 2017 standards.

It's actually even better than that, because as you can see below, I haven't been able to track down the actual current membership number for "Buckeye Community Health" (aka Ambetter)...and Buckeye is asking to lower their rates slightly, by around 1% on average. To get an idea of how this could impact the statewide average:

  • Assuming 0 enrollees: No impact at all; 13.1% average.
  • Assuming 10,000 enrollees: Would reduce avg. to 12.4%
  • Assuming 50,000 enrollees: Would reduce avg. to 10.1%
  • Assuming 100,000 enrollees: Would reduce avg. to 8.1%

Again, without knowing how many people Buckeye/Ambetter actually has currently enrolled, it's impossible to say what the weighted statewide average is...but I can say that it's no more than 13.1%.

(sigh) Once upon a time, there were 24 ACA-created Co-Ops. Then, after one of them failed to even make it through the 2nd open enrollment period, a variety of factors (culminating in the infamous Risk Corridor Massacre) caused another dozen or so to curl up & die, falling like dominoes throughout last September/October.

When the dust settled, there were 11 Co-Ops left standing, but most of them were still on pretty shaky ground, with all but a handful placed under "enhanced oversight" by their states (and I have to admit that the term sounds an awful lot like a euphamism, a la "enhanced interrogation technique").

Thanks to Richard Simpkins for bringing this to my attention.

A week or so ago, Akash Chougule, Director of Policy at Americans for Prosperity (you know, the Tea Party political outfit funded by the Koch Brothers), posted an Op-Ed piece at Forbes tearing apart Ohio Governor John Kasich's decision to expand Medicaid via the Affordable Care Act. From a Republican POV, of course, Kasich agreeing to accept ACA Medicaid expansion is blasphemous. The piece was posted just ahead of the Ohio Republican Presidential primary, so naturally it was intended to hurt his chances of winning his home state (it didn't work, of course; Kasich did indeed win Ohio, keeping his campaign alive awhile longer, if just barely).

Anyway, here's the part which made both Simpkins and myself scratch our heads:

Ohio Governor John Kasich has spent no small amount of time on the presidential campaign trail discussing his decision to expand Medicaid to 650,000 able-bodied adults under Obamacare. But policymakers in non-expansion states should take a closer look at what’s actually unfolded in Ohio before considering going down the same path.

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