What’s next

Now that open enrollment is winding down, the execution phase for 2014 is in full swing and the planning cycle for 2015 will be wrapping up soon.  After that, insurance companies and their state regulators will build for 2015 implementation.  So what should we be seeing in the next month or so.

1) Cleaning out the pipeline.

The first task is to complete open enrollment for on-Exchange policies.  All people who signed up on Healthcare.gov but could not complete their application by last night still have a chance to finish their application.  If they checked their blue box, they have until mid-April to complete their application.  This is a fairly simple task for all entities.  The website should have breathing room after yesterday’s peak load, navigators will be able to rest for a couple of minutes, and enrollment counselors at the call center will have a chance to talk people through the process.  Insurance companies will have sufficient time to process enrollments on the dreaded 834 file and get ID cards out for May 1st.

2) Continue enrollment for Medicaid and qualifying life events

Enrollment does not stop.  People who are eligible for Medicaid or CHIP can enroll at any time.  We should expect to see the Expansion states to steadily add people to Medicaid as informal social networks as well as formal recruiting networks will pull more people in.  People who don’t qualify for Medicaid or CHIP can still buy new policies on the Exchanges if they have a major life event.  A major life event can be the start or end of a marriage, birth, adoption, or death of a family member, a big move and a big change in income.  I’ll write more about this later this week.  A major life event is a “qualifying event” which means people have a 30 day window to change their insurance situation to match the new personal situation.  I don’t expect a ton of movement, but I do expect a steady trickle of changes and additions.

3) States must decide what they want to do for 2015

States face a few major decisions.  The first is how they want to manage their Exchange for 2015.  State built exchanges can continue to build out capability, or like Maryland, they can junk their system and buy proven technology from Connecticutt.  State built exchanges have the option to go to healthcare.gov.  States already on Healthcare.gov have the choice to continue on with the Federal Exchange or build/buy their own.  As anti-asshole Adler insurance, I hope states that have a Democratic governing coalition but are on Federal Exchanges move to state run Exchanges.  Additionally, states must decide what the minimal standards for network adequacy are for Exchange qualified plans and make the choice as to whether or not they want to actively manage competition like California or act as a clearinghouse like the Feds.

4) Health insurance companies must decide what 2014 looks like

Initial plans for 2015 are due to the states and the Feds in only a couple of weeks.  Pricing for 2015 is a soft target right now as the actuaries and underwriters don’t have a complete data set.  They won’t have a complete data set until May, and even then there is certainty that the April and May effective date policies are held by people who are statistically seperate from the people who signed up in 2013.  There are some data pooling services available for actuaries to make a guess as to what actual costs will look like this year, and what they could look like next year, but there are significant assumptions.  Insurance companies will need to make a set of decisions as to what 2014 looks like in the next couple of weeks.

5) Health insurance companies file for 2015

Health insurance companies take a look at the results of Step 3 and 4 to make their plans for 2015.  Insurers have the option of withdrawing from markets, staying the same, modifying offerings or adding products.  I’m assuming most insurers are modifying and adding new products and new service areas.  I am also assuming (based on co-ops and the fact that open enrollment was successful) that we should see more insurance companies enter the Exchange market.  All companies need to file their proposed rate structures to their state regulating entities in the next few months.  Companies that are adding or changing plans need to file their plans and networks to their state regulators in the next six to eight weeks.  Over the summer, the state regulators and insurers will play ping pong until there is a mutually satisfactory set of proposals or proposals are withdrawn.

These are the five big moving parts for this spring.  There will be more, but these are the important changes.

18 replies
  1. 1
    raven says:

    So you anticipate that those of us in BCBS plans will see costs rise?

  2. 2
    Richard Mayhew says:

    @raven: I don’t know. I don’t have access to their data and if I did, I would be under a serious non-disclosure agreement.

    I expect rates to go up because rates go up, that is what they do for my entire life, but I don’t think, in general for most states/most policies, they’ll go up much.

  3. 3
    NotMax says:

    Are there any factors built into ACA mitigating a company unilaterally withdrawing from a state exchange prior to open enrollment for 2015 (presumably their coverage continues until Dec. 31 regardless)?

  4. 4
    JPL says:

    When will the DC court release their opinion on subsidies and federal exchanges?

  5. 5
    Yatsuno says:


    Why for do you hate the Nutmeg State?

    @raven: It’s possible, but in WA rate increases need serious justification. All state insurance commissioners are still watching this shit & not happy that some of their powers have been taken away from them. I think it’s gonna vary by state, and the fed program will have a slight nudge up, though my BC/BS actually went down one year.

  6. 6
    raven says:

    @Yatsuno: These douchebags in Georgia will probably make them go up just to piss everyone off.

  7. 7
    raven says:

    @Richard Mayhew: I’m sorry, I just was looking for a gut. Your stuff is so great!

  8. 8
    rikyrah says:

    Obamacare enrollment drive’s secret weapon: Radio

    By Olivier Knox, Yahoo News

    …But a look inside the Affordable Care Act’s all-out enrollment drive shows that — for all the talk about social media and unorthodox strategies — the Administration relied heavily in the final stretch on a century-old way to reach the public: Radio.

    On Monday, senior Obama adviser Valerie Jarrett did her first radio interview at 8:30 am. By 6:30 pm, she was on her 21st, bringing her total over the past six weeks to 82.

    She has done them from her office, home, car, an airport runway, her hotel room. Some DJs she has spoken to did not have health insurance before the Affordable Care Act but have now signed up, a White House aide said. Some DJs – like Joe Madison, to whom she spoke on Monday — have amplified the administration’s message by playing stories of callers helped by the law.

    Overall, top administration officials – and celebrity surrogates – have taken part in some 300 individual radio interviews, according to administration figures shared with Yahoo News.


  9. 9
    Richard Mayhew says:

    @raven: Not a problem — and honestly, my gut is probably a 4% to 7% increase on average in most states — but I have no data to base that on.

  10. 10
    raven says:

    @rikyrah: They also had great ad’s on the NCAA’s last weekend!

  11. 11
    Ronnie Pudding says:

    Any chance the insurance companies will be given more time to figure out how to play it next year, or are there reasons their dates can’t be pushed back? I can see the companies saying Obama’s extensions (plus the site launch foul up) means they need more time to figure out what to do next year.

    Also, do the various companies see each others new pricing before releasing their own? If in one state, a bunch of companies either drop out our boost rates, can someone else in and take advantage? Or is this sort of direct competition done with a year delay, so to speak?

  12. 12

    Question: Are states who opted into expanded medicaid able to opt out later?

  13. 13
    Patricia Kayden says:

    I also expect that “what’s next” is Republicans trying to sabotage the ACA. It was nice to see photos of people lining up to get healthcare in TX and FL, even though those states are run by anti-ACA Republicans.

  14. 14
    Mnemosyne says:

    @Patricia Kayden:

    Would you like to see a great picture of Mrs. Obama visiting a community health clinic in Miami? I knew you would! :-)

  15. 15
    Richard Mayhew says:

    @Frankensteinbeck: yes — IIRC, Virginia is proposing to do a 2 year trial at 100% Fed money, with the option to get out when the state has to kick in cash.

  16. 16
    Richard Mayhew says:

    @Ronnie Pudding: Both — each company releases their own pricing to the state, the state looks at it and gets back to the companies and the public. The company has several weeks/months (depending on state) to tweak things around due to either state regulator concerns OR competitive market concerns.

  17. 17
    Origuy says:

    @rikyrah: A lot of radio DJs are musicians or comedians, or have connections in those fields. You’re always hearing about someone who gets sick or injured and their friends are holding a fundraiser. They should be solid advocates for the ACA.

  18. 18
    Churchlady320 says:

    @Richard Mayhew: Remember that what YOU pay is linked to your income, not the market, so if rates rise, much of it is absorbed by the federal funding, not by the consumer. Rates have FALLEN in even private plans outside the Marketplace, and the rate of increase has been reduced remarkably. Usually it was double digits annually. Now it’s single numbers and as low as 2%. But that is not on you if you have a subsidy.

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