2020 Exchange expectations

Insurers are currently preparing their initial rate filings for 2020 right now. Submissions will be due in a few weeks. So what should we expect?

I think we should expect stability as the rule set if fairly constant going from 2019 to 2020. Insurers know that the only major potential policy shock is an adverse ruling from the 5th Circuit and the Supreme Court in Texas v Azar. That is a low probability event. Silver loading is allowed and common. CSR payments are slowly working their way through the court system but there will be no final judgement to trigger regulatory intervention. Essential Health Benefits have not been touched except at the edges. This is a policy stable year. It is the first policy stable year since 2016 policy year pricing season.

For the 2017 policy year, actuaries were trying to adjust to the loss of federal reinsurance and the Presidential election.

For the 2018 policy year, actuaries were trying to price in the possibility of repeal and replace as well as CSR termination.

For the 2019 policy year, actuaries were trying to estimate if they had overpriced 2018 and estimate the impact of Silverloading as well as mandate repeal.

For 2020, there is clarity about the bigger questions from 2019 but no new policy curve balls.

I expect more individual market insurers to enter new markets and expand their footprints.

Here are the major pricing pressures for the actuaries to worry about.

  • General medical trend (5% to 10%)
  • Health Insurance tax (3%)
  • Changes in risk pool due to individual mandate repeal (0% to ???)
  • Changes in risk pool due to low cost plans being available (0% to -???%)
  • Short term limited duration and Association Health Plans (0% to ???)

This will vary by state.  States that publicize individual mandates will see healthier and bigger risk pools than states that either don’t have a state based individual mandate or have a state based individual mandate and absolutely no advertising about it.

States that have filed for 1332 waivers for reinsurance will see less premium pressure than states without reinsurance.

States that fully expand Medicaid to 138% Federal Poverty Level will see lower premium increases than states that have not expanded Medicaid.  This will be most evident in Utah, Idaho, Virginia and Maine as the roll-out ramps up.

The short version of this post is that 2020 is the first “normal” operational year for the ACA exchanges over the past several years.  We should see “normal” changes to premiums.

7 replies
  1. 1
    Chris Johnson says:

    Insurers are currently preparing their initial rate filings for 2020 right now. Submissions will be due in a few weeks. So what should we expect?

    This does really illustrate the deep powerlessness issues we have with all this.

    Sounds like a new fashion line, but for death through inability to make use of health care resources.

  2. 2
    Butch says:

    So right now I’m having to file a series of protests and appeals because Blue Cross denied a claim for “preventive and wellness” services. Just a thought about our current health insurance system.

  3. 3
    Anonymous At Work says:

    How much should and can insurers try to second-guess 2020 election impact on 2021 conditions in order to begin curving things correctly in their 2020 calculations? Or are we talking a bridge too far?

  4. 4
    daveNYC says:

    I hope you didn’t just jinx Texas v Azar.

  5. 5
    taumaturgo says:

    Mr. Anderson forgot to take into the account the 15 to 20 % profit margins that we all pay to compensate the profit before care insurers honchos. Who knew a dreaded disease was to become a money-making machine and a bankruptcy sentence for the afflicted?

  6. 6

    Just got back from having my hearing checked, and am glad to say it’s normal. So yay for that health care news.

    I conclude Mr DAW really does mumble.

  7. 7
    Steeplejack says:

    @Dorothy A. Winsor:

    Are you sure he’s speaking English?

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