Regular readers know that I've spent the past 4 months painstakingly tracking and analyzing the 2018 individual market rate filings for pretty much every insurance carrier in every state across the country.
I've completed this process for 46 states + DC. I've confirmed (well, really, Louise Norris confirmed for me) that the filing data for the four missing states--Kansas, Missouri, Nevada and Utah--won't be made available publicly for another couple of weeks, which is irritating...but those four states combined only make up about 5% of the total population anyway; unless their average rate increase requests are significantly higher (or lower) than the average of the rest of the states, they aren't gonna move the needle up or down by more than a tenth of a point or so.
The details, caveats, disclaimers and methodology behind my estimates can all be found here, and of course the averages vary widely from state to state, carrier to carrier and even plan to plan. Also, many of these requests will change by the time the 5th Open Enrollment Period starts on November 1st, due to additional shuffling of carriers dropping out or expanding coverage, resubmitting filings, having their requests changed by state insurance regulators and so on. NATiONALLY, however, this is what it looks like. Bold-faced numbers mean I'm highly confident in the weighted average; non-bold means I'm reasonably confident but there's considerable margin for error:
Yes, that's right: Overall, nationally, carriers are asking for around a 29% average rate hike assuming CSR payments aren't guaranteed for 2018 and the individual mandate penalty isn't enforced...or around 14% assuming that CSR payments are guaranteed. As noted above, it's more difficult to separate out the individual mandate threat because most of the filing justification letters either don't mention it at all or only refer to it in vague terms ("increased morbidity expected due to changes in federal policy", etc.)...but there are some major carriers which have indeed specifically called it out and even attached a hard number to the impact.
Overall, to the best of my judgement, the national picture looks very close to the following: Roughly 19 percentage points, or around 2/3 of the total, is due to either the CSR Payment or Mandate Enforcement factors, with the remaining 10 points (around 1/3 of the total) due to actual increased cost of medical services (including prescription medications), as well as the reinstatement of the ACA's carrier tax (see pie chart at top).
I have additional graphs/charts over at the main ACA Signups site which break this data out further, but they’re too high-resolution to display properly here.
------—--------------
On a more personal note...
I've been operating ACASignups.net for nearly 4 years now. As many of you know, it started out as a nerdy hobby thing I did in my spare time, but quickly overtook my life. I always planned to shut it down after the first Open Enrollment Period ended back in April 2014...and then in March 2015...and again in 2016. Year after year, people clamored for me to keep it going one more year.
At this point a year ago I really planned on winding things down as of around April 2017. My reasoning was simple: If Hillary Clinton succeeded Barack Obama as President, there probably wouldn't be that much ongoing interest in my work here. After all, I figured, it's not like there are websites devoted to breathlessly tracking Social Security enrollments in real time. After four years, I assumed that interest in the site would drop off enough that it would be time to archive the site and refocus on my day job. Yes, that's right: I have a day job as a freelance website developer. I know that's hard to believe given how much time I spend on ACA/healthcare matters, but it's true...and frankly, I've been increasingly neglecting that business more and more of late, right when I should have been building it back up again.
Needless to say, that’s not quite how things worked out. Many people have informed me that ACASignups.net has instead become more vital than ever, with a new mission on top of the old one: I’m no longer merely tracking the progress of the ACA, I’ve spent the past six months helping the fight to save it ...and that fight is far from over. We may have won the official Congressional battle to repeal it (for now), but the sabotage effort by the Trump Administration is still in full swing...and even if we win that battle, the next chapter is clearly shaping up to be where the healthcare reform saga should turn next?
Until now, I've received support for my work here through a combination of banner ads and one-time donations via PayPal and GoFundMe, and I'm eternally grateful to those who've helped out. I’m especially grateful to the Daily Kos community, who chipped in for a big fundraiser after 3 years ago after the first Open Enrollment Period; I had lost nearly half my business at the time and you guys really saved my butt.
Time marches on, though, and if I'm going to continue working on this site, analyzing healthcare data, debunking fake/misleading claims and educating the public about how the ACA works, the real problems it has, how to fix them and where we should go from here, I need to have a more stable, consistent source of support. That's where Patreon comes in.
If you're not familiar with Patreon, it's pretty simple. Instead of making a one-time pledge/donation the way that you do with fundraising sites like KickStarter or GoFundMe, with Patreon you pledge to make a small monthly donation on an ongoing basis. It actually starts at just $1/month, with additional tiers from there. Here’s a really good article explaining the backstory.
It's similar to a subscription-only site, but without the limitations--all content on ACASignups.net will still be available to all visitors, it's just that you'd be supporting me over at Patreon, where I'll also be adding some additional content/analysis there as well. For those who pledge higher support levels, I'll be experimenting with a few more bells & whistles like the occasional podcast and/or livestream Q&A, that sort of thing. (Of course, if you'd prefer to stick with a one-time donation, the PayPal/GoFundMe routes are also still available!)
Anyway, check it out and please consider becoming a patron today!
UPDATE: In the comments, you’ll note that someone flat-out accused me of allegedly not previously giving a shit about those who have seen their rates increase dramatically under the ACA...primarily those on the individual market who don’t qualify for tax credits or who only qualify for nominal credits...namely, those earning between around 300-500% of the federal poverty line.
This is not only offensive, but an insane accusation considering that my wife and I are both self-employed, on exchange policies and with an income ranging between 300-500% FPL.
In other words, we’re exactly who they referred to as being genuinely hurt by ACA policy rate hikes.
This person then went on to ask me to provide evidence that I’ve griped about this before. That’s really not my job here (if you accuse someone of something, it’s up to you to cite your evidence), but just for the record, I did exactly that less than a month ago...ironically, in what amounts to an earlier version of this diary:
For the past three years, my wife, son and I were enrolled in a BCBSMI Gold PPO plan via HealthCare.Gov. Due to our highly-variable income (we're both self-employed, so it jumps up and down a lot year to year), some years we receive a tax credit, other years we don't.
This year, however, the rates for the Gold PPO jumped up about 18% or so, so we downgraded to a Gold HMO instead....smaller network, but cheaper premiums. Just gotta be careful not to go out of network. As a result, our unsubsidized premiums run about $1,200/month for the three of us.
Assuming Blue Care Network receives the full "Trump Tax" rate hike they're asking for next year, that $1,200/month will shoot up to around $1,471/month...an increase of $271/month, or $3,254 for the year. Ouch.
However, I do owe an apology for my profane initial response. My emotional reaction was justified, my actual choice of words wasn’t.
UPDATE x2: Back to the main diary: Yes, Alaska, Oklahoma and Minnesota could potentially see rate decreases next year, without sabotage for very specific reasons: In Oklahoma’s case, BCBSOK jacked up rates over 70% this year; thanks to the ACA’s 80/20 MLR rule, they’re pulling things back a bit for 2018. For Alaska and Minnesota (as well as Oregon, which is looking at nominal non-sabotage increases), the answer is that they’ve implemented a state-level “reinsurance” program, which amounts to the government stepping in and covering a big chunk of the cost of really expensive enrollees. Reinsurance can be very effective, but it needs federal funding. Ironically, both the House and Senate GOP bills included reinsurance funding...but at the expense of a whole mess of other horrible stuff, plus the reinsurance money was basically stolen from Medicaid.
IMPORTANT UPDATE x3: A few people have expressed confusion/concern about what actually happens to those currently receiving CSR assistance in the event the payments are killed.
Unlike premium tax credits, CSR assistance (around $7B this year, expected to hit around $10B next year for around 7 million people) is paid by the insurance carriers TO the doctors/hospitals. The carriers are then reimbursed by the federal government the following month for money they already spent.
Here’s where it gets weird, though: The carriers are contractually required to continue providing CSR assistance whether they’re reimbursed by the gov’t or not. That means that if you qualify for a CSR policy (exchange-based Silver plan with an income <250% FPL), your carrier HAS to keep providing the CSR assistance no matter what as long as you’re enrolled in that policy.
The irony here is that CSR enrollees aren’t the ones who would be hurt by CSR payments being cut off...it’s everyone else on the individual market who would, because their rates would shoot up ~15% to cover the difference.
The only danger to CSR enrollees is if the carrier decides to throw their hands up in disgust and drop out of the ACA exchange altogether...which some of them are doing.
In other words: IF YOU’RE RECEIVING CSR ASSISTANCE OR WILL BE ELIGIBLE FOR CSR HELP NEXT YEAR, YOU’LL BE OK AS LONG AS A CSR PLAN IS STILL AVAILABLE.
But it gets even stranger. There’s a complex workaround which could potentially turn the CSR cutoff lemon into lemonade. I call it the “Silver Switcharoo”, and I explain how this works in a 2nd diary here.