New Hampshire Insurance Department Study Commission on the Future - PowerPoint PPT Presentation

New Hampshire Insurance Department Study Commission on the Future of the NH Premium Assistance Program Tyler Brannen Health Care Policy Analyst January 9, 2017

Agenda • Role of the NH Insurance Department • NH Insurance Markets • Impact of the 2014 ACA changes • Premiums

The Basics • Insurance is regulated at the state level – The ACA is a federal law • NH is a “partner” state under the ACA – NHID enforces compliance with state laws and makes recommendations to CMS for products on the exchange • Half of “commercially insured” people are covered by self-funded employers

NH Commercial Market Source: NHID 2015 Medical Cost Drivers report, November 2016

Source: NHID 2015 Medical Cost Drivers report, November 2016

Individual Market Participants New Hampshire Individual Market 2014 2015 2016 2017 Anthem/Matthew Thornton Celtic/Ambetter Assurant/Time Harvard Pilgrim Minuteman Community Health Options Off Exchange Only On and Off Exchange Prepared by Gorman Actuarial, Inc. 6

What Changed in 2014? • New market rules for individual and small group markets – Guaranteed issue, sunset of high risk pool – Essential health benefits • Emergency services, hospitalization, Maternity & newborn care – New rating factors - individual • 2013: age, health status, tobacco • 2014: age, tobacco, geographic (permissible) – Metal levels – Individual insurance coverage requirement 7

Introduction of Premium Subsidies – Substantial subsidies are available through the exchange for those at 100%-400% of federal poverty (FPL) – 2014: • Individuals: $11,490 - $45,960 • Family of 4: $23,550 - $94,200 – Those under 100% FPL are not eligible for subsidies • Assumed to be covered by Medicaid 8

Modeling Changes to 2014 Premiums Morbidity of Individual Market vs High Risk Pool 30.0 25.0 20.0 Axis Title 15.0 27.0 10.0 5.0 3.0 1.0 0.0 Individual Market State High Risk Pool PCIP PCIP = Federal Pre-existing Condition Insurance Plan (temporary) Source: New Hampshire Market Study Key Findings, Gorman Actuarial, Inc. September 2012

Modeling Results Premium Impact CY 2014 Individual Market HRP/PCIP 40% Newly Insured 6% Reinsurance -8% Minimum Actuarial Value 2% Medical Loss Ratio Requirement -6% Cumulative CY 2014 30% Source: New Hampshire Market Study Key Findings, Gorman Actuarial, Inc. September 2012

2013 to 2014 Membership Changes Change December % 2014 1 from 31, 2013 Change 12/31 Individual Market 34,817 60,795 25,978 75% Federal and State High Risk Pools 2,613 802 -1,811 -69% Fully Insured Group 188,913 178,909 -10,004 -5% Self Insured 293,009 291,338 -1,671 -1% Medicaid 118,537 127,968 9,431 8% Total Membership 637,889 659,812 21,923 3% 1 2014 membership is based on updated enrollment as of May 1, 2014 received from Anthem. Federal High Risk Pool Enrollment is as of January 31, 2014. All other 2014 enrollment is as of April 1, 2014. Source: New Hampshire Health Insurance Market Analysis, Wakely Consulting Group, August 2014

Distribution of New Hampshire Fully-Insured Membership Individual Exchange NH PAP Individual Non-Exchange Indiviudal Exchange Small Group Large Group Data Source: NHID Annual Hearing data 2015 and 2016, Gorman Actuarial, Inc. 12

Premium Level and Trends Data Source: NHID Supplemental Data Request 2014, 2015 and 2016; Gorman Actuarial, Inc. 13

Components of Premium CY 2015 Individual Small Group Large Group Medical & Pharmacy Claims Admin Expenses & Fees ACA Charges Profit (Positive) Profit (Negative) Other State & Federal Taxes *Information shown prior to any federal MLR rebate payments Data Source: 2015 federal MLR reports provided by insurers. Anthem provided additional information for FEHBP to make necessary adjustments 14 to exclude from Large Group. Gorman Actuarial, Inc.

2017 Individual Exchange Product Increases Company/Product Rate Increase Ambetter 1% HPHC ElevateHealth HMO 10% HPHC NH Network HMO 9% MTHP/Anthem HMO 13-17% Minuteman 2-10% ACA compliant individual plans in NH with effective dates of 1/1/17, from healthcare.gov.

Thank You Contact Information New Hampshire Insurance Department Tyler Brannen 21 South Fruit Street, Suite #14 Health Care Policy Analyst Concord, NH 03301 NH Insurance Department requests@ins.nh.gov Tyler.Brannen@ins.nh.gov Phone: (603) 271-2261 Fax: (603) 271-1406 TTY/TDD: 1 (800) 735-2964 www.nh.gov/insurance 3/16/2017 Page 16