Charles Gaba's blog

Some of you may recall that a couple of months ago, I was asking for people to vote for a Netroots Nation 2016 panel with myself and 3 other healthcare experts having an all-out “Incremental Progress vs. Single Payer Now!” healthcare debate.

This subject seemed especially ripe for discussion especially given the massive brouhaha from back in January when I reviewed Bernie Sanders’s so-called “Medicare for All” proposal (which actually wouldn’t be Medicare at all, but that’s a different discussion), along with the raging debate which followed both here and across the blogosphere as well as mainstream media websites as well over the next month or so.

As I noted at the time, normally, all 90 panels are chosen by a NN committee, but this year they decided to leave 10 slots open to “public voting”, allowing anyone to create a NN account, log in and vote daily for their favorite panel.

Throughout last September and October, I chronicled the dominos-like downfall of a dozen ACA-created Co-Op insurance carriers. They tumbled, one by one, as a result of a perfect storm of problems, some of which dated back to the final version of the ACA which was signed into law; others which cropped up along the way:

Conrad's plan called for $10 billion of government grants distributed among nonprofit, member-owned health insurance startups. The money came with few restrictions. Competing against big for-profit insurers is difficult, Conrad said. The co-ops needed as much freedom as possible to ensure their survival.

Just 2 days ago I noted that the Arizona state Senate was refusing to vote to reinstate the KidsCare program (aka, Arizona's name for the federal CHIP program) for absolutely no legitimate reason, since the program a) would provide 30,000 low-income children with healthcare coverage which would b) be 100% paid for by the Federal government and would c) bring them in line with every other state in the nation.

Well, it appears that at least some Republicans in Arizona do have at least a bit of decency:

Republican lawmakers maneuver to force a vote on KidsCare, reviving a debate over the role of government in people's lives vs. personal responsibility

Chastened and angry over their failure to reinstate KidsCare, Republican lawmakers in the Arizona House got Democrats to join them Thursday in a successful bid to revive the children’s health-insurance program.

Almost exactly 1 year ago over at healthinsurance.org, I posted the following:

May 15 officially marked the start of the 2016 rate review season. What that means for Americans is that over the next month or so, newspapers and web sites across the country will start running stories with scary-sounding headlines like this:

Some Oregonians could face major insurance rate hikes next year

Health plans request double-digit premium increases

… or, more reassuringly, like this:

Lower rate increases, more plans proposed for state’s health exchange in 2016

The articles will throw a bunch of numbers around, saying that the “average” premium rate increase for a given state is expected to be X percent, followed by examples of the highest and lowest increases. There may even be a few “Company Y will actually be reducing their rates!” thrown in.

Before you freak out, there are a few important things to look for.

This is really just a summary of my last 4 posts. I've combed through the SERFF databases for every state which uses the system for rate filings, and while very few have the actual 2017 rate filing requests listed yet, at least 4 of them have official individual market exit letters submitted for 2017 from Jane Rouse, the Product Compliance Process Owner for Humana Insurance Co:

This list may grow as additional state filing data and/or press releases come out from Humana, but assuming these are the only 4 states Humana is bailing on, the news isn't quite as bad as it appears at first.

To keep things in perspective, add the 4 numbers above up and it's 25,512 people across 4 states with a combined population of 21.8 million. Put another way, these 25.5K people represent only 2.9% of the 875,700 people Humana currently has enrolled in individual policies (both on & off exchange) nationally.

To be clear, I'm not saying this is a good development; when you combine it with the recent UnitedHealthcare Dropout Odometer it's more of a drip-drip-drip sort of thing. But it isn't disasterous for the exchanges either (at least not yet).

UPDATE: I've been informed by a reliable source that Humana is also dropping out of the individual market in Nevada next year, although I don't have any actual enrollment data there. Humana is not currently participating on the Nevada exchange, however, so any dropped enrollments would be OFF-exchange only. In fact, I'm pretty sure that the only individual market enrollees Humana has in Nevada are grandfathered policies anyway, so the numbers should be pretty nominal there.

Yep, sure enough, Humana is following UnitedHealthcare out the door of multiple states next year. That's 1,800 people impacted, although they're all OFF-exchange only:

I already noted last month that Humana is dropping out of Virginia's individual market next year, but since I'm in a "Humana pulling out!" mode this morning, I might as well post their official exit notice for completeness. Thankfully, the impact is nominal in Virginia, as only 1,800 people are being impacted total.

It's also worth noting that "grandfathered" enrollees only make up around 11% of Humana's total Virginia individual market as of this spring, which is somewhat higher than my overall ballpark estimate of around 1 million nationally.

 

Alabama

Just like in Wisconsin, Humana appears to be pulling up stakes on the individual market in Alabama as well...but unlike Wisconsin, Humana is operating on the ACA exchange this year. With UnitedHealthcare already having announced that they're leaving Alabama as well, Humana dropping out in 2017 will leave Blue Cross Blue Shield of AL as the only individual market carrier operating on the exchange in the state unless someone else jumps in (although I believe there are some carriers offering individual plans off-exchange only):

Last month I noted that the Washington HealthplanFinder enrollment report was simultaneously clearcut and confusing at the same time:

According to the ASPE report, as of 1/31/16, 200,691 people had selected QHPs via the WA exchange. This is completely consistent with the exchange's own final report of "more than 200,000".

However, according to their March monthly enrollment dashboard report, the Washington HealthplanFinder only had 176,914 people having "Selected a Plan" as of February...and of those, only 156,493 were reported by the carriers as having paid.

That payment rate is a quite reasonable 88.5%, which is slightly lower than my general 90% rule of thumb estiamate nationally but not out of line at all. However, what's the deal with that 177K topline figure? Where did the remaining 23,777 people go?

Well, the WA exchange just released their April report (which includes data through March) and while the numbers are better, the original mystery remains.

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