Regular readers know that I used to regularly post an entry about the official CMS Medicaid enrollment reports every month, documenting the increase in Medicaid enrollment since ACA expansion went into effect. The numbers were increasing dramatically every month for nearly two years, but started slowing down last fall as most of the expansion states started maxing out on their eligible enrollees.
As of November 2015, there had been a net increase of 14.1 million people added to the Medicaid rolls since October 2013 (the month when ACA expansion enrollment began), plus another 950,000 people who had already been quietly transferred over to Medicaid from existing, state-funded programs prior to 2013 via other ACA provisions. I sort of forgot to post about the reports for awhile, but checked back in again for the May report, released back in July.
Over at the National Review, Michael "King v. Burwell" Cannon of the CATO Institute and self-described Obamacare-slayer has penned a piece which tears into the ACA over the situation in Pinal County, Arizona, where, barring a last-minute development, several thousand residents are about to find themselves in a pretty unpleasant situation when it comes to finding a new healthcare policy for 2017. As I noted last week:
Pinal County won’t have a company offering marketplace health insurance plans next year following the nation’s third-largest health insurer’s decision to exit public exchanges in all but four states.
Aetna was the only insurer planning to offer Affordable Care Act plans in Pinal County for 2017. It currently only sells in Maricopa County but had planned to expand to Pinal County.
More than 75,000 Iowans will see their insurance premiums rise next year.
Iowa Insurance Commissioner Nick Gerhart has approved rate increases sought by four companies who provide health insurance in the state, Gerhart's agency announced Monday. The increases include plans covered by Wellmark Blue Cross & Blue Shield, the state's dominant health insurer.
However, the article was a little vague about some of the data, so I visited the IA DOI website and sure enough, they have separate entries for every one of the carriers (with one exception):
A week or so ago, I attempted to tally up the number of current ACA exchange enrollees who will have to shop around for a new policy this fall whether they want to or not, due to their current plan being discontinued. As a reminder, there are three main reasons for this: a) the carrier is pulling out of the exchange in their county/state (Aetna, Humana, UnitedHealthcare); b) the carrier is going out of business entirely (4 co-ops); or c) the carrier will still have policies available but is dropping the one they're enrolled in (mainly PPOs).
In addition to the 1.69 million estimate from Aetna, UnitedHealthcare, Humana and the 4 Co-Ops which are shutting down in CT, OH, IL and OR, we can also add the following (thanks to Louise Norris for the assist on some of these):
Two weeks ago, on August 14th, I officially concluded my requested 2017 rate hike project. I've since gone back and made some adjustments to various states where carriers have either pulled out of the individual market or resubmitted revised rate hike requests, but I had enough preliminary data from all 50 states (+DC) to come to some initial conclusions.
I sorted out the states by three different criteria, looking for any noteworthy patterns: Federal vs. State-Based Exchanges; Transitional Policies allowed vs. NO Transitional Policies; and whether or not the state has expanded Medicaid under the ACA (whether "standard" Medicaid or via a custom waiver version, like Arkansas, Indiana and New Hampshire did).
My conclusion at the time was that there wasn't enough of a distinction in either of the first two criteria to draw any conclusions...but as for Medicaid expansion, I said:
Over at Politico, Rachana Pradhan and Paul Demko have an interesting article speculating on the potential for the ACA-as-a-GOP-campaign-issue to spring back to life again due to the one-two punch of major carriers dropping out of the exchanges and significant rate hikes being imposed for the 2017 Open Enrollment period. The fact that #OE4 kicks off (November 1st) just 1 week before election day (November 8th) adds some fuel to this thinking:
The potential sticker shock — coupled with the likelihood many consumers will have fewer choices next year after major insurers scale back their exchange participation — creates a potential political opening for Republican candidates, especially since the next Obamacare enrollment season starts one week before Election Day.
Here's a peek under the hood of what a royal pain in the ass it is to keep track of all this stuff, here's a comment exchange I had with several site regulars a couple of days ago:
Charles Gaba: Actually, I did find *one* useful item...it looks like quite a few of the carriers *resubmitted* their filings later in the summer (my data is currently based on the requests from April/May).
So, we still don't have *approved* rates but the *requests* can be updated...
Some of it is odd---Aetna said they're *staying* on the exchange in Virginia...but it shows up here as being *new* to the exchange, even though they're a) already listed for 2016 over atData.HC.gov and b) I already have an exchange-based filing for them with over 13,000 current enrollees and a 13% requested hike. Huh.
joe: Aetna's 2016 plans are sold under Innovation Health Insurance Company. They were going to introduce new Aetna Leap plans in 2017.
Believe it or not, Indiana's individual market situation is actually among the brighter spots this year. While three carriers are dropping off of of the ACA exchange market (and Physicians Health Plan is dropping off-exchange policies as well), they're also seeing the addition of a new carrier (Golden Rule), and one major carrier, Celtic, actually requested and received an average reduction in their monthly premiums, which is pretty rare this go around.
Unfortunately, the overall average approved statewide increase, while still lower than most of the other states so far, is actually slightly higher than the requested average. Every carrier got what they asked for with the exception of Indiana University, which asked for a 9.9% hike but was approved for a 14.9% increase. This bumped the statewide average up from 17.7% to 18.5%:
The average premiums range from an increase of 29 percent by Indianapolis-based Anthem Inc. to a decrease of 5.3 percent by Chicago-based Celtic Insurance Co.
Usually when state regulators publicize their approved rate changes for carriers on the independent market, they list the various carriers and the approved average rate changes for each. I then simply plug these into my existing spreadsheet and get a before/after comparison against how much the carriers actually requested.
In the case of illinois, it's a little trickier. Unless I'm missing something, the only official notice the IL DOI has released is this PDF, which--while including lots of useful info about rating areas and so forth--doesn't actually list the overall statewide average approved rate increases by carrier.
Instead, it lists the averages based on metal level, and even then doesn't list all of the plans, just selected ones: Lowest-price Bronze, Lowest and 2nd Lowest-price Silver, and Lowest-price Gold, like so:
Virginia was the very first state which I ran an estimated 2017 average requested rate hike for, way back in mid-April.
Since then, aside from Humana pulling out (leaving just 1,800 current enrollees to find a new policy), Virginia's ACA exchange market has actually been remarkably calm; the state somehow managed to escape the wrath of both UnitedHealthcare and Aetna relatively intact, with both carriers still participating in the state's exchange next year as of this writing.
There have, however, been a few other changes to some of the rate filings here and there, found via this updated PDF on the VA DOI website as of July 19th. The overall average requested hikes don't really change much, but do nudge a bit higher than I had previously estimated, from 17.5% to 18.4%:
