Quote:

 

http://www.nytimes.com/2015/06/02/business/seeking-rate-increases-insurers-use-guesswork.html

Seeking Rate Increases, Insurers Use Guesswork

In a sign of the tumult in the health insurance industry under the Affordable Care Act, companies are seeking wildly differing rate increases in premiums for 2016, with some as high as 85 percent, according to information released on Monday by the federal government for the 37 states using HealthCare.gov as their exchange.

The data from the Centers for Medicare and Medicaid Services included only proposed rate increases of 10 percent or more, and federal officials emphasized that it would be months before final rates were set. Regulators in some states have the authority to overrule rate increases they deem to be too high.
[and the insurers can then refuse to offer plans, as we're already seeing]

Experts cautioned against relying too heavily on the data as a predictor of prices for next year.

“Trying to gauge the average premium hike from just the biggest increases is like measuring the average height of the public by looking at N.B.A. players,” said Larry Levitt, an executive with the Kaiser Family Foundation.
[just relax and experience the slow death!]

But many insurers, including those seeking relatively hefty increases below 10 percent, say they are asking for higher premiums because they remain unsure about the future and what their medical costs will be.

“The insurers are in the business of taking risk, but the one thing they hate is uncertainty,” Mr. Levitt said.

Many unknowns remain. Among them are the questions of how many more people will sign up for coverage and what the state of their health will be. Healthier customers can generally lower costs for the overall group. Other uncertainties include the effect of the law’s protections against large losses for insurers, and a Supreme Court decision that will determine whether subsidies will be available in the states participating in the federal exchange.
[Congress left them certain on the 3-R's issue and the SCOTUS case has ZERO to do with these premiums, as HHS re-wrote the law to allow them to IMMEDIATELY drop coverage if they lose.]

Some of the requests for premium increases show how insurers are struggling to find the right balance between keeping their prices low enough to attract customers but high enough to cover costs — and make a profit.
[They wrote the law to provide profit no matter what, except they forgot to appropriate the bailout funds.]

In Delaware, the state’s insurance regulator said on Monday that two insurers asked for much higher rates in 2016: Highmark Blue Cross Blue Shield sought a 25 percent increase, while Aetna wanted an increase of 16 percent.

“Large rate increase requests like these are occurring in several states across the country,” said Karen Weldin Stewart, the Delaware insurance commissioner, who said she planned to try to reduce those rate requests.

In Georgia, Alliant Health Plans is seeking increases as high as 85 percent for some plans, with an average increase of 38 percent, according to the filing listed on the federal website, ratereview.healthcare.gov. The insurer declined to comment on the filing.

But there are wide variations in some states. In Maryland, for example, while CareFirst BlueCross BlueShield is seeking a 30-percent increase for some of its plans, others including Cigna, Kaiser Permanente and United Healthcare are proposing to lower premiums for some plans.

Federal officials point out that consumers will have a choice of plans, just as they did last year. Many people kept their costs low by switching plans; 29 percent of those who re-enrolled picked a different policy from the previous year.
[So that tells you up to 71% auto-re-enrolled likely experienced a premium hike they must pay themselves ...oops! The rate hikes actually make that auto-re-enroll system a bigger problem for next year.]

Some insurers like Anthem, one of the largest for-profit companies, say they do not expect significant increases in most markets. Most of the for-profit insurance companies have reported strong financial results, benefiting in part from the subsidies that have generated millions more paying customers.

But others say they need to adjust rates because they miscalculated their medical costs and the strength of the competition.

“Some may have been overly optimistic and some may have been pessimistic,” said Sabrina Corlette, a health insurance researcher at Georgetown University. “It’s so difficult because there are so many different factors at play.”

In Tennessee, BlueCross BlueShield said it lost $141 million on individual policies sold on the exchange because it was paying $1.14 in medical care for every dollar in premiums. The company has requested an average rate increase of 36 percent.

Many people signing up were much sicker than the insurer expected, said Roy Vaughn, a spokesman for the Tennessee plan. “We’re trying to get it as right as we can,” he said.

In some cases, the miscalculations are causing insurers to rethink their strategy. Faced with significant losses from selling policies on the exchange, Assurant Health, a for-profit insurer that had been an aggressive participant last year, said it was looking for someone to take over its business or it would leave the market in 2016.

In Connecticut, HealthyCT, one of the consumer-oriented co-op plans created under the federal law, is requesting an average rate increase of 14 percent, after decreasing premiums for 2015.

Whether state regulators will agree to the increase request remains an open question, said Ken Lalime, the co-op’s chief executive. “I don’t know if that’s the final number we’ll end up with.”

Like many insurers, HealthyCT said it was less protected from losses as provisions of the law that were meant to encourage companies to enter the market were phased out. Insurers are also uncertain whether they are enrolling people who are sicker than customers of their competitors and whether they will be reimbursed for their higher risk.

“It’s the year of actuarial uncertainty, and actuaries are conservative,” said Dr. Martin Hickey, chairman of the National Alliance of State Health CO-OPs and the chief executive of the New Mexico exchange. “The safest thing to do is to raise rates.”

And while the companies say they have not generally seen a rapid rise in medical costs that would cause them to raise rates sharply for 2016, Mr. Lalime and other executives are quick to point to the high cost of new drugs like those used to treat hepatitis C.

Ms. Corlette and others say they believe insurers will continue to try to offer low prices, especially for midlevel plans. While insurers may not be overly optimistic that there will be a large number of additional customers signing up next year, the fact that people have switched plans may mean they can still capture market share. “It may change the incentives,” Ms. Corlette said.

As insurers gain more experience in the market, the expectation is that they will be confronted with fewer surprises. And while the Supreme Court decision is not expected to affect next year’s pricing, insurers are uncertain about that as well.

Many plans have decided to take a sit-back-and-wait posture about the case, said Richard M. Judy, a principal in PwC’s health consulting business.

“Health plans have put so much time and effort getting ready for these exchanges,” he said. “It would be a crushing blow to see that all unraveled.”

Quote:

 

http://www.wsj.com/articles/state-officials-had-secret-huddle-on-health-law-subsidies-1433202161

State Officials Had Secret Huddle on Health-Law Subsidies
Few contingencies were found if the Supreme Court rules some Affordable Care Act credits should be voided

...The meeting was organized by the Milbank Memorial Fund, a health-policy foundation, which said it paid for plane tickets and hotel accommodation for as many as two representatives from each state. Participants said people from 16 or 17 states attended.
[Trouble counting in double digits? Take your shoes off, idiots!]

...But several attendees in Chicago said they doubted their governors or legislatures could agree to such an option amid opposition to the health law, especially from Republicans. Of 34 states that didn’t set up their own exchanges, only seven currently have Democratic governors, and only one of those also has a Democratic legislature.

...a few supporters of the law are eyeing fresh workaround options, that even they aren’t sure will work. One possibility is that an agreement, rather than a contract, could be drafted between a governor and the Obama administration to establish a state’s exchange. Others are looking into whether the Department of Health and Human Services could say states have established their own exchanges already by helping the federal government operate an exchange on a state’s behalf.

“What if HHS declared that any state that performs substantial, ongoing, and essential exchange functions has established an exchange, even if the state never formally elected to do so?” Nick Bagley, a University of Michigan law professor whose opinions are widely sought by supporters of the law, wrote in a recent blog post.

Mr. Bagley said in an interview that such an approach would hinge on legal definitions of the word “establish” that suggest it can occur unwittingly. “You can establish lots of things,” he said. “You can formally establish a smoking habit without even choosing to do so.” But, he said, it would face stiff legal odds.

The Obama administration hasn’t discussed contingency planning should the Supreme Court strike down the subsidies.

• 
  
• The Honorable Mark Mazur
  Assistant Secretary for Tax Policy
  Department of the Treasury (invited)
  
  
• Ms. Emily McMahon
  Deputy Assistant Secretary for Tax Policy
  Department of the Treasury (invited)
  
  
• Ms. Cameron Arterton
  Deputy Tax Legislative Counsel for Tax Policy
  Department of the Treasury (invited)

Quote:

 

http://khn.org/news/california-sees-housing-as-significant-investment-in-health-care/

California Sees Housing As Significant Investment In Health Care

[...]

“I am too old and sick to be back out there on the streets,” he said. “It kind of takes a toll on a person.”

Health officials handpicked him and about 100 other ill homeless residents to live in the Star Apartments, a sleek white building with a medical clinic on the bottom floor. The apartments are part of a multimillion dollar experiment: Using county health care dollars to house people who are chronically homeless.

“If we don’t, they tend to die young on the streets,” said Marc Trotz, director of the Housing for Health program in Los Angeles County, which officially began in 2012. “And they just continually recycle through expensive health care settings.”

Now, California wants to take the approach statewide. It is asking the federal government for permission to use Medicaid money to help put the most medically fragile homeless people in housing.

Mari Cantwell, deputy director of the state health care services department, said health care and housing traditionally have been in distinct silos. “We are really trying to look at the whole person,” she said. “And our belief is that this will improve health care and reduce costs.”

Under the Affordable Care Act, hundreds of thousands of homeless residents who previously didn’t qualify for government health insurance became eligible for Medicaid. Federal health officials suddenly became responsible for many people with longstanding illnesses, including mental disorders and substance abuse. Realizing the potential costs, they began considering different ways to help patients without overburdening taxpayers.

Selling the federal government on California’s idea won’t necessarily be easy. The Centers for Medicare and Medicaid Services turned down a request from New York to house chronically ill homeless patients, saying it isn’t in the business of paying rent. New York now pays for such housing with state Medicaid funds. Other states, including Massachusetts and Louisiana, are using federal dollars not for rent but for services that keep specific populations, such as those with severe mental illness, in housing.

California’s proposal could be the most comprehensive of its kind, allowing Medicaid to cover a broader population on a consistent basis. The federal money would pay for case managers to help people get whatever they need to stay in housing except for rent – including transportation, job assistance and substance abuse treatment. Any savings could be used by managed care companies to invest directly in providing housing, in partnership with local governments and others. California does not yet have estimates on how much federal money it might need.

Carol Wilkins, a consultant and author of a recent report on “supportive housing” for the U.S. Department of Health and Human Services, said counties don’t have the resources to continue doing these projects on their own. Medicaid needs to step in and recognize housing-related services as health care costs, she said.

[...]

Quote:

 

http://www.wsj.com/articles/health-law-enrollees-on-track-to-meet-administrations-revised-goals-1433274727

Health Law Enrollees on Track to Meet Administration’s Revised Goals
Government reports 10.2 million consumers signed up and paid for coverage under health law

A total of 10.2 million people signed up for health insurance under the Affordable Care Act and paid their premiums by the end of March, the Obama administration said Tuesday, indicating the administration is on track to meet its revised goal.

The administration had said last year that it expected to have between 9.1 million and 9.9 million consumers paid up and enrolled in insurance plans through state and federal online exchanges in 2015.

The latest figures, released by the Centers for Medicare and Medicaid Services, showed a drop from the nearly 11.7 million people the Obama administration said on March 9 signed up or had been automatically re-enrolled for coverage in state and federal marketplaces but hadn’t yet necessarily paid premiums. It is common in the insurance industry for a certain percentage of customers who sign up for a policy to end up not paying for it.

The number of consumers who both enrolled and paid is important because the health law’s supporters tout robust numbers as a sign of success toward the law’s goal of boosting the number of insured Americans. A high attrition rate or tepid enrollment would galvanize critics, who say consumers aren’t paying premiums because of frustration with their high costs or narrow provider networks in the health plans.

[...]

Nearly 6.4 million consumers in 34 states that rely on the federal exchange received an average subsidy of $272 a month, according to the CMS report. That is roughly equal to the final enrollment numbers from last year.

[...]

The exchanges previously were expected to sign up 13 million people for 2015, according to an April 2014 projection by the Congressional Budget Office. Ms. Burwell said in November that she expected to hit 9.1 million by the end of 2015, within a range that could go as high as 9.9 million. The lowered target—millions fewer than outside experts had predicted—was based on early trends in the enrollment period.

“It has to be a disappointment,” said Douglas Holtz-Eakin, president of the American Action Forum, a center-right think tank, and former director of the Congressional Budget Office. “They are constantly moving enrollment numbers and [re]setting the bar for success.”

[...]

Nearly 70% of the 10.2 million Americans who had signed up and paid premiums had selected what are known as silver plans, where the plan pays 70% of health costs on average and the consumer pays about 30%. The next most popular were bronze plans, a lower-cost option where the health plan pays 60% on average. About 1 in 5 consumers selected that option.

• 
  
• 70% paid thru Silver Plans
  
• premiums going up (for those too lazy to avoid auto-re-enrollment)
  
• minimum out-of-pocket (deductible+copay) on single coverage is $2,050+/-

Quote:

 

http://www.latimes.com/nation/la-na-obamacare-enrollment-20150602-story.html

Latest Obamacare enrollment total slips but still outpaces 2014
[Implies success is higher enrollment than the previous year?]

Nationwide enrollment in health plans provided through the Affordable Care Act slipped to 10.2 million in March as consumers dropped coverage or failed to pay premiums on policies they selected, the Obama administration announced Tuesday..

That is down from 11.7 million sign-ups recorded in February when the 2015 enrollment period closed.

The tally still represents growth over 2014, when 6.3 million people were enrolled in health plans at the end of the year, according to updated 2014 figures also released Tuesday.

[...]

Quote:

 

http://www.nytimes.com/aponline/2015/06/02/us/politics/ap-us-health-overhaul.html

More Than 10M Enrolled This Year Under Obama's Health Law

More than 10 million people have signed up for private health insurance this year under President Barack Obama's law, the administration said Tuesday. That puts the nation finally within reach of coverage for all, but it may not last.

The report from the Department of Health and Human Services comes as dozens of insurers are proposing double-digit premium hikes for next year, raising concerns about future affordability.

[...]

kbp

Jun 3 2015, 08:31 AM

...Nearly 6.4 million consumers in 34 states that rely on the federal exchange received an average subsidy of $272 a month