Connecticut

2018 MIDTERM ELECTION

Time: D H M S

The Reinsurance Train keeps chugging along.

In 2017, three states established their own ACA market reinsurance program utilizing the ACA's Section 1332 State Innovation Waiver provision to keep unsubsidized premiums from spiraling out of control in 2018 and beyond: Alaska, Minnesota and Oregon.

For months now, I've been trying to get people to understand that when it comes to sabotage of the Affordable Care Act, especially in terms of individual market premium increases, you have to include the impact of actions taken by Donald Trump and Congressional Republicans in BOTH 2017 and 2018, not just 2018 alone.

In 2017, the single largest factor in the ~28% average national unsubsidized premium increase for ACA plans was Donald Trump's cutting off of Cost Sharing Reduction (CSR) reimbursement payments to carriers. This alone accounted for fully half of the 2018 increase. However, there were other, smaller actions taken which added up to another 3% or so: Slashing the Open Enrollment Period in half, CMS slashing the marketing budget for the federal exchange down 90%, slashing the outreach/navigator budget down 40% and so on.

This just in from the Connecticut Insurance Dept...

The Connecticut Insurance Department is reviewing 14 health insurance rate filings for the 2019 individual and small group markets. The filings were made by 10 health insurers for plans that currently cover about 293,000 people.

Two carriers – Anthem and ConnectiCare Benefits Inc. (CBI) – have filed rates for both individual and small group plans that will be marketed through Access Health CT, the state-sponsored health insurance exchange.

The 2019 proposed rate increases for both the individual and small group market are, on average lower, than last year:

This post actually has almost nothing whatsoever to do with the Affordable Care Act itself.

Every year I dig through hundreds (thousands?) of insurance premium rate filings for carriers in every state. For the most part I ignore everything except for my core focus area, the Individual Market, although on occasion I also try to run analysis of the Small Group market filings as well. I don't really pay much attention to the Large Group market filings.

However, there's a bunch of other types of health/medical insurance as well, and one which I've written next to nothing about since I started the ACA Signups project is also one which is becoming increasingly important as the Baby Boomer generation retires: Long-Term Care insurance.

To illustrate my point, here are a few recent premium rate increase filings from carriers in Connecticut:

Long-Term Care Rate Filing - Connecticut Life & Health Guaranty Association (Individual)

Rate request: 69 percent increase
Decision: Approved January 9, 2018

A few years ago, New York State passed a law which allows uninsured pregnant women to enroll in ACA exchange coverage outside of the official Open Enrollment Period. Here's what Louise Norris and I wrote about it at the time:

On another note, I also want to use this as an opportunity to point out that maintaining quality health insurance coverage needs to be a priority year in and year out. Jenks notes that "Pregnancies are often unplanned, making limited enrollment periods impractical for many women." But can't that be said of any medical condition? In fact, I would say pregnancy is one aspect of healthcare that's probably much more likely to actually be planned. While about half of pregnancies are planned, I doubt the same could be said for cancers, heart attacks, or car accidents.

In other words, while not all pregnancies are planned, overall it's a lot less "random" than most other expensive healthcare incidents.

Now that the 2018 Open Enrollment period is officially over in every state +DC, I've started compiling more detailed demographic breakouts of the data on a state-by-state basis. The official CMS report from the Assistant Secretary for Planning & Evaluation (ASPE) report should be released at some point in the next couple of weeks, but until then, I'll have to settle for whatever reports I can patch together from some of the state-based exchanges.

So far I've dug up final (or near final) data for six states: Colorado, Connecticut, Idaho, Maryland, Minnesota and Washington State. Collectively, these states only represent about 890,000 2018 exchange enrollees, or roughly 7.5% of the 11.8 million total, so I have no idea how representative they are nationally, but it's all I have to work with for the moment.

The type of demographic data available varies greatly from state to state, but a major data point available from all six of them also happens to be one of the more interesting points, especially this year, given the " CSR Silver Loading" gambit available in most states this year.

At this point, the only significant top-line 2018 Open Enrollment numbers missing are the final 10 days out of California (which could add perhaps 40,000 to the total) and a solid month of enrollment from the District of Columbia (23 days, actually, but they extended their deadline by 5 extra days, which may or may not be included in the final, official report from CMS). DC's tally through 1/08 was 21,352 QHP selections. Their all-time high was around 22,700 set in 2016, so I can't imagine that they added more than perhaps 2,000 more since 1/08. In other words, about 99.5% of the 2018 OEP QHP selections have likely been accounted for.

That means it's time to move on to...breaking down the demographic data! Woo-hoo! Parrrr-tyyyy!!

The big, official CMS report from the Assistant Secretary for Planning and Evaluation (ASPE) presumably won't be released for a couple of weeks, but some of the state-based exchanges are faster about posting their demographics. First up: Connecticut!

Access Health CT already reported their top-line 2018 Open Enrollment Period number and a few other data points via Twitter a couple weeks ago, but they just issued a more detailed press release:

LT. GOV. WYMAN: DEMAND FOR HEALTH INSURANCE ROSE, 2018 OPEN ENROLLMENT STRONGER THAN PREVIOUS YEARS

(HARTFORD, Conn.) – Lt. Governor Nancy Wyman and Access Health CT (AHCT) CEO Jim Wadleigh today provided the results of the Connecticut healthcare exchange’s fifth open enrollment period, which ran from November 1 to December 22, 2017. During this open enrollment cycle, 114,134 residents signed up for private health insurance coverage, reflecting a 2.3 percent increase compared to enrollment figures last year.

No official press release yet but AccessHealthCT just released a series of tweets with their official final numbers...

114,134 CT residents have enrolled in a health plan for 2018 - 2.3% more than last year! #AHCT

— Access Health CT (@AccessHealthCT) January 8, 2018

This may be a little anticlimactic, but AccessHealthCT has added another 7,600 enrollees in the past 5 days and still has two days to go...

Connecticut's Health Insurance Open Enrollment In Its Last Hours

Open enrollment on the state’s health care exchange, Access Health Connecticut, ends Friday at midnight. 

Connecticut residents had one week longer to sign up for an insurance plan than customers of the federal site, healthcare.gov.

As of Thursday morning, some 106,000 people had signed up for health care plans through Access Health CT.

Exchange CEO Jim Wadleigh called this the most challenging open enrollment period in the five years it’s been up and running, citing uncertainty over the future of the health care law, mixed messages from the Trump administration, and the shortest enrollment period ever, at just seven weeks. 

Hmmm...a week ago AccessHealthCT reported just over 92,000 QHP selections as of December 8th, leaving 9,380 current exchange enrollees who still had to actively choose a new policy.

Today they've updated their enrollment tally to 98,376 (with 7,800 left to choose a plan)...but the thru date still reads December 8th.

I'm assuming whoever posted the update simply forgot to also update the "as of" date; presumably it's as of yesterday (December 14th), but I've put in a request for clarification.

UPDATE: Yup, they've since corrected the date to read 12/15/17 (basically, as of this morning I presume).

It's important to note that today is not the deadline for Connecticut residents to enroll; AccessHealthCT's deadline isn't until next Friday, December 22nd.

A small update out of Connecticut today; AccessHealthCT last reported just over 90,000 QHP selections as of November 30th, with 11,000 current enrollees who hadn't selected a 2018 policy yet. Today they've updated that to 92,041 QHPs as of this morning, leaving 9,380 left to renew.

This means they added 1,613 more people in the past week, but the pool of current enrollees dropped by 1,675, which means that at least a small number have actively cancelled their policies altogether. Looked at another way, the number of new enrollees has increased by 3,211 (from 11,749 to 14,960), which means that, again, a couple thousand current enrollees who either actively (or were passively) auto-renewed have since gone back into the system and changed their mind and cancelled their 2018 plans. This is normal, especially for the states which "front-load" auto-renewals before the December deadline passes.

Access Health CT has just posted their full November enrollment numbers: 90,428 QHP selections thru 11/30, of which 13% are new enrollees.

For comparison, last year they enrolled 111.5K people, so they've hit 81% of their 2017 number and 78% of their 2016 number.

They've also done something interesting: They're listing the 11,055 current enrollees who haven't actively re-enrolled as of yet. If every one of them did so (they won't), that would bring the grand total up to 101.4K.

Not much of an update, but good to see a hard number officially posted at AccessHealthCT (I assume they'll be updating this regularly from the looks of it):

 

No precise numbers yet, but this tweet from Access Health CT gives the key numbers:

To date, over 17K CT residents have enrolled in a plan for 2018 - with 6K new to #AHCT. #shopshopshop #AHCTBoDMeeting #GetCoveredCT

— Access Health CT (@AccessHealthCT) November 16, 2017

Assuming "to date" includes yesterday (11/15), this gives us a perfect year over year comparison; last year AccessHealthCT had 16,085 people enroll in Qualified Health Plans in the first 15 days (9,455 renewals + 6,630 new), so they appear to be up about 6% year over year so far.

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