If the pie chart above looks familiar, that’s because I’ve posted different versions of it in the past. The first time was about 3 months ago, when the chart represented the requested average unsubsidized individual market health insurance policy premium increases for 2018. The second time was a 2 months ago, when I had updated it to represent the approved rate increases across about 20 states. A few weeks ago I posted it a third time, with 30 states, representing roughly 54% of the total U.S. population.
I’ve added 9 more states since then, and have now compiled 2018 rate increase data on 39 states covering about 80% of the total U.S. population.
There’s also been one other major change since the last rate hike update: That big red chunk on the left-hand side has changed from the theoretical to reality, with Donald Trump officially pulling the plug on Cost Sharing Reduction (CSR) reimbursement payments to insurance carriers.
The detailed methodology and all individual state calculations can be found here (scroll to the bottom for individual state links).
Here’s a summary view. Overall, around 58% of the 2018 rate increases are tied directly to either the threat to Cost Sharing Reduction (CSR) reimbursements or concern over enforcement of the Individual Mandate penalty...both of which are being caused specifically and deliberately by the Trump Administration in both cases (and by the GOP Congress to a lesser extent):
What’s remarkable is how consistent things have stayed throughout the entire process. Yes, the national average has jumped up and down a bit, and the proportion of it which can be tied to the CSR and/or mandate enforcement issues varies from state to state, but in general the total has hovered in the same ~30% range for quite awhile and the CSR portion seems to consistently make up around 40-50% of that.
Here’s the state-by-state breakout of the 30 states which have released approved rate increases for next year so far:
As you can see, the averages range widely:
At the low end: 22% and 5.3% REDUCTIONS in average premiums in Alaska and Minnesota respectively (both instituted reinsurance programs, although the Centers for Medicare & Medicaid pulled a fast one on Minnesota by effectively stealing the money from their Basic Health Plan program).
At the high end: Jaw-dropping 50%+ rate increases in Georgia and Virginia.
IT’S VITALLY IMPORTANT TO REMEMBER THAT THESE ARE UNSUBSIDIZED RATE INCREASES. Roughly 9 million people on ACA exchange policies receive tax credits which should also change to match these rate changes...so if you receive subsidies and your policy increases $200/month, your tax credits should also increase by around the same amount.
The problem, as always, is that the tax credits cut off for anyone earning more than 400% of the Federal Poverty Level (roughly $48,000/year for an individual or $97,000/year for a family of four). Anyone earning over 400% FPL are the ones who are in for some major pain this fall...except in states which utilize the Silver Switcharoo Gambit, which currently appears to include the following 12 states:
- California
- Connecticut
- Florida
- Hawaii
- Idaho
- Minnesota
- Nevada
- Pennsylvania
- Rhode Island
- South Carolina, and
- Washington State
In these 12 states, in theory, it’s possible that NO ENROLLEES in the individual market will end up having to be hit with the CSR load...in fact, many subsidized enrollees will be able to save money by shopping around and considering upgrading to a GOLD plan, since gold plans may end up costing less than silver in many areas!
Meanwhile, unsubsidized enrollees in these states won’t save anything, but they should be able to avoid the CSR hit by switching to a different metal level (or choosing a special off-exchange silver plan instead). They might have to pay the normal increase, but it should be much less without the CSR load as well.
IN ANOTHER 23 STATES (and possibly more), subsidized enrollees will end up doing better shopping around and possibly looking at a gold plan; these are the “Silver Load” states. Unfortunately, in these states, unsubsidized enrollees will indeed be hit with some of the CSR load.
As I keep stressing, even if Trump’s HHS Dept. wasn’t sabotaging the Open Enrollment Period (killing advertising for HC.gov, slashing outreach, cutting the enrollment period in half, etc etc), things would still be crazy-weird thanks to the CSR/mandate mess...so even if you don’t think you’ll qualify for financial assistance (or think you’re gonna be worse off whether you do or not), make sure to ACTIVELY shop around instead of simply letting yourself be automatically re-enrolled.
If you’d like to help help my efforts on these and other healthcare policy issues, I could always use whatever support you're able to provide, either as a one-time thing or on an ongoing monthly basis.