Charles Gaba's blog

Amidst all the hand-wringing over how much healthcare premium rates are expected to go up next year, there's one factor which I haven't really mentioned before. I've probably made a passing reference to it here and there, but I don't think I've focused on it prior to this entry.

Old people, generally speaking, require more medical care than young people. This isn't an absolute, of course; there are 60-year olds who can kick a 30-year old's ass, and while younger people tend to be healthier than the elderly, they also tend towards more risky behavior, be it reckless driving, bungie jumping or whatever. Still, the fact remains that there's a reason why insurance carriers lust after so-called "Young Invincibles" so much: They tend to be relatively low-risk and inexpensive to treat when something does come up.

The conventional wisdom when it comes to taxes is that Republicans are always for cutting 'em while Democrats are always for raising 'em. The reality, of course, can be far more complicated--it's not just about cutting or raising taxes, it's also about who's getting the increase/decrease and what the money would/no longer would be used for. Even so, this is an odd-sounding story at first glance.

Just last week, the Big News Shocker out of Oklahoma was the blood-red Republican-controlled state legislature and governor were actually considering a) raising taxes (!!!) and b) expanding Medicaid via the ACA (!!!) in order to dig themselves out of their self-dug financial hole:

So, in what would be the grandest about-face among rightward leaning states, Oklahoma is now moving toward a plan to expand its Medicaid program to bring in billions of federal dollars from Obama's new health care system.

What's more, GOP leaders are considering a tax hike to cover the state's share of the costs.

This year only 3 insurance carriers are offering policies on the individual market in Rhode Island: Blue Cross Blue Shield, Neighborhood Health Plan and UnitedHealthcare. The bad news is that United is pulling out of RI, although they only hold about 4% of the on-exchange market anyway. The rest of the on-exchange market is split almost evenly between BCBS and Neighborhood.

Both Neighborhood Health Plan and BCBS have submitted their filings, and there's some great (and surprising, for this year) news:

Carriers file two average rate increase amounts with OHIC: the EHB base rate increase and the weighted average rate increase. These two percentages reflect different calculations.

It's true: High deductibles and co-pays are a serious and growing problem for many people. HOWEVER, the most depressing finding of this morning's survey results by the Kaiser Family Foundation was this one:

The survey also finds a lack of awareness about new rules for coverage introduced by the ACA. Among all those with ACA-compliant coverage, fewer than half (47 percent) know that preventive services are covered completely by their plans, while a third (33 percent) think that copays or deductibles apply to preventive services and one in five (20 percent) are not sure. Among those in high-deductible plans, awareness is even lower: 41 know that preventive services are covered with no cost-sharing.

Therefore, I now present a list of services which are covered at no cost whatsoever to anyone enrolled in an ACA exchange health insurance policy:

The Kaiser Family Foundation has just released their 3rd Annual survey of people enrolled in the "Non-Group Health Insurance Market", otherwise known as the Individual market. It's important to note that this survey includes Americans enrolled in all individual market plans, both on and off-exchange. There are technically 5 separate categories, although they can effectively be merged into three categories for most purposes:

• 1. EXCHANGE-based QHPs (Qualified Health Plans)
• 2a. OFF-Exchange QHPs
• 2b. OFF-Exchange ACA-compliant non-QHPs
• 3a. OFF-Exchange NON-ACA compliant "Grandfathered" plans (ie, enrolled in prior to 2010)
• 3b. OFF-Exchange NON-ACA compliant "Transitional" or "Grandmothered" plans (ie, enrolled in between 2010 and 2013)

I tend to merge #2 & 3 together (off-exchange, ACA-compliant) in virtually all cases, and merge #4 & 5 together (grandfathered/grandmothered) except in cases where I need to make a distinction.

A source who doesn't wish to be named attended the annual meeting of the Wisconsin Common Ground Co-Op the other day (Common Ground is one of the 11 Co-Ops which survived last year's Risk Corridor Massacre), and forwarded a few tidbits of info:

• CG is closely watching the class action lawsuit filed by the now-defunct Oregon Co-Op against the federal government over the lost risk corridor payments, as CG would benefit from a win in the case.
• CG is open to considering outside investment funding now that CMS is allowing the Co-Ops to pursue it, but isn't scrambling to seek it out just yet. They did note that Wisconsin has a law applying to the Co-Op which requires that all board members use it for their own insurance (which makes total sense, actually). Since any outside investor would likely be on the board, they'd also have to utilize CG coverage.
• CG is requesting 12.5% weighted average rate hikes for 2017, which is actually at the lower end of the spectrum nationally so far this year. They're also adding a new Silver plan.
• I was also provided with an image of their overall financials for 2015 (see below). They didn't have much to say about this year since it's only May but seemed comfortable with how things are proceeding so far, and said their MLR (medical loss ratio) is "dropping" although from what to what I have no idea.

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.

Just last week I ran the rate filing numbers for Maine and came up with an overall weighted 20.6% average hike request. Today I've learned three things:

• It turns out Maine's insurance dept. has their own rate review/filing website which is more up to date than the standard SERFF database;
• Some of the enrollment numbers for each carrier are slightly different from the SERFF forms; and
• It turns out that Aetna a) already has indy policy enrollees off-exchange (only 700 of them) and b) is planning on joining the exchange for 2017, as they had hinted at last week.

Here's what it looks like with the revisions...the overall average barely changes at all, but it's still a more complete picture:

Unlike most states, New Mexico uses their own, in-house rate review database.

The good news is that it's easy to use, and lists all of the carrier rate hike requests in a clearcut manner...except, oddly, for CHRISTUS, which I'm pretty sure is being offered this year.

The bad news is that it doesn't include any of the actual market share/enrollment numbers, making it impossible to come up with a weighted average. Some of these are available via redacted filings over at the federal RateReview.Healthcare.Gov site, but not all of them. I have New Mexico Health Connections estimated at 48,000 based on this report, but I have no idea how many CHRISTUS or Presbyterian enrollees there are.

The RateReview site lists CHRISTUS as ranging from 9.4 - 15.2%, but without market share numbers I can't even come up with a proper rate hike request, so I've split the difference for now at 12.3%.

Thanks to Zachery Tracer (as well as Dan Goldberg & Cynthia Cox) for the heads up...

Well, now...this is about as cut & dry as it gets! They don't display the actual enrollment numbers for each carrier, but that's OK because the only real reason I need it in the first place is to weight the increases by market share...which the New York Dept. of Financial Services has helpfully already done!

And there you have it: A weighted average requested rate increase of 17.3% across the entire state's ACA-compliant individual market. Remember that NY never allowed transitional plans anyway, and there are likely only a handful of grandfathered plans left on the individual market, so this should cover well over 90% of the market.

They also included the Small Group market, which I take note of when available but don't really track nearly as closely as the indy market: