Charles Gaba's blog

The Idaho insurance department website has made this really easy for me. Most states either don't provide the requested rate hikes at all (forcing me to track them down via a slew of SERFF filing forms) or, if they do provide the rate requests, they don't provide the actual enrollment numbers for each carrier, making it very difficult to run a weighted average.

In the case of Idaho, they don't give the enrollment numbers, but they've already ran the average and posted the weighted number for me! Better yet, they've done this for both the Individual and Small Group markets:

One of the biggest challenges the HHS Dept. has encountered when it comes to enrolling people in ACA exchange policies has been encouraging (or "goading" depending on your POV) millennials into signing up. This is important for several reasons:

Hmmm...this is kind of interesting. As I noted a few weeks ago, here's what the QHP enrollment pattern has looked like in Minnesota since the end of the 2016 Open Enrollment Period:

  • 11/01/15 - 1/31/16: 85,390 (or 928/day); 33,333 MNcare; 73,173 Medicaid
  • 2/01/16 - 2/14/16: 85,690 (+300, or 21/day); 39,887 MNcare; 90,234 Medicaid
  • 2/15/16 - 3/06/16: 86,856 (+1,166, or 55/day); 45,621 MNcare; 111,449 Medicaid
  • 3/07/16 - 4/17/16: 90,696 (+3,840, or 91/day); 55,357 MNcare; 156,983 Medicaid
  • 4/18/16 - 5/22/16: 91,868(+1,172, or 33/day); 64,040 MNcare; 195,295 Medicaid

Here's the latest report from the MNsure 6/15 board meeting:

UPDATE 6/22/16: I've been informed that there was a coding glitch with Utah's website which prevented several carrier rate filings from being listed. I've gone back and plugged in the additional carriers, which account for about 32,000 more Utah residents...but which only moves the weighted average slightly, since Molina's request is fairly close to the 30% average I already had estimated.

This leaves around 93K unaccounted for. Some of them are presumably enrolled via University of Utah plans; U of U's enrollment numbers are redacted, and while the Utah site claims a 0% rate hike, the RR.HC.gov database lists it as 4.47%.

Also, as far as I can tell, "American Medical Security Life Insurance Co." is a branding for UnitedHealthcare, which should clear up that confusion.

Full Disclosure: The Robert Wood Johnson Foundation has long-term paid banner ads on this website.

Having said that, I don't think anyone would disagree that the RWJF is a pretty reliable source for this sort of national healthcare data analysis:

The Widespread Slowdown in Health Spending Growth Implications for Future Spending Projections and the Cost of the Affordable Care Act

The United States is on track to spend $2.6 trillion less on health care between 2014 and 2019, compared to initial projections made right after the 2010 passage of the Affordable Care Act (ACA).

The Issue 

  • The report uses health expenditure data produced by the Centers for Medicare and Medicaid Services and consistently adjusts in each year for the absence of the sustainable growth rate system for physician payment rates in Medicare.

Key Findings

UPDATE: It turns out that Humana is not dropping out of Michigan entirely; they're only dropping their PPO plans, not their HMOs.

I noted last month that like UnitedHealthcare, Humana is pulling out of the individual market in multiple states next year. Unlike United, however, both the number of states and the number of enrollees impacted by Humana's withdrawl is fairly nominal; at the time I counted 5 states and around 25,000 total enrollees. Since then, Humana has confirmed that they're also dropping out of Colorado (9,914 enrollees), for a total of roughly 35,400 people nationally.

Today, I've confirmed that Michigan can be added to the list, impacting 1,717 people enrolled in off-exchange PPO plans. This brings the total to around 37,000 nationally:

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%.

*("Approved" is preliminary; see below)

Oregon was the second state to publicly announce the rate changes their carriers are requesting for the 2017 individual and small group markets. The overall weighted average request on the individual market side came in at a requested 27.5% increase, while the small group market requests had an average increase of just 1% overall (I didn't weight the small group enrollment numbers at the time, but have done so below).

Yesterday (thanks to commenter farmbellpsu for the tip), the Oregon Dept. of Insurance announced preliminary approved rates for 2017:

After a brutal two years in which they lost a collective $253.3 million, Oregon's health insurers are again seeking double-digit price hikes in 2017.

Hey, remember this (September 2014)?

Yeah, yeah, I know; a test server for Healthcare.Gov was successfully hacked into recently; no sensitive data was stolen, but Security was Breached, etc etc etc.

No, I'm not shrugging the incident off. I'm the one who called Hawaii's state exchange website out for taking over a week to resolve their own Heartbleed SSL vulnerability last spring. Yes, security is very important, especially with personal financial, medical and citizenship data. Hopefully the HHS techies are eliminating vulnerabilities, beefing up security and so forth.

I'm swamped with my day job at the moment, so I don't have a whole lot to add to the discussion at the moment...

HOWEVER, this line from GOP Rep. Diane Black in Avik Roy's latest ACA attack at Forbes.com literally made me laugh out loud:

via Bob Herman of Modern Healthcare:

The Affordable Care Act's exchanges have not been a bust for every health insurer. Florida's Blue Cross and Blue Shield affiliate made a profit of almost a half-billion dollars on the ACA's new individual plans last year.

The substantial ACA exchange losses exhibited by large health insurers—such as Health Care Service Corp., Highmark, Humana and UnitedHealth Group—have emboldened the law's critics and worried investors about whether the new marketplaces will ever achieve sustainability.

Yet many other companies, including Medicaid insurers Centene Corp. andMolina Healthcare and now Florida Blue, have had no difficulties making money on the new ACA plans, which often have narrow networks of hospitals and doctors as well as high deductibles.

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