Insurers want to raise Obamacare rates as much as 53 percent

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2018 could be another year of steep Obamacare rate hikes.

Early data from state insurance departments, released over the past two weeks, shows that big health plans are requesting some pretty significant premium increases.

Anthem, which covers 35,000 people in the Connecticut marketplace, wants to raise premiums 33.8 percent. BlueChoice, a Maryland plan that covers 160,000 people, has asked for a 53.4 percent hike. And in Virginia, 295,000 individual market enrollees are on track for an average increase of 30.6 percent.

Five states — Connecticut, Maryland, Oregon, Virginia, and Vermont — as well as the District of Columbia have so far released 2018 rate increase requests from Obamacare insurers. This is our first glimpse into how much coverage could cost next year, and it suggests that many Obamacare enrollees could be paying a lot more.

You can see the range of rate increases that insurance plans have requested in this chart I pulled together, using data from state insurance departments.

First things first: These are requested rate increases, not the final numbers. It's helpful to think of these numbers as health plans' opening bid in a negotiation with the state insurance department. This is how much insurance plans want to raise rates, and insurance commissioners will be charged with evaluating whether these rate increases are reasonable. So there is decent reason to believe some of the especially big numbers might decline a bit in the process of those negotiations.

Still, let's not beat around the bush: These are big, big rate increases that insurance plans are asking for. A 50 percent requested rate hike that falls to 40 percent or even 20 percent in the course of negotiations is still a big increase.

The big question: Why are insurance plans requesting such big rate hikes?

It is incredibly hard to pinpoint which part of the rate increases are a product of the instability and uncertainty the Trump administration has created around Obamacare's future — and which part reflects a marketplace that was already struggling.

There are some clear ways the Trump administration has driven up rates. For example: CareFirst, a big marketplace carrier in the DC area, has tacked 15 percent onto its rates because it does not expect the White House to enforce the individual mandate.

But other factors leading to the 2018 rate increases aren't so clear-cut. Lots of insurance plans have said in their rate filings that they are worried about a "shrinking market" or sicker enrollees that will drive up premiums. Here's what Anthem, for example, told regulators in Connecticut about why it wanted a 33.8 percent rate increase:

We are forecasting that the indiviudal market will continue to shrink and that those individuals with greater health care needs will be the most likely to purchase coverage and retain their coverage, thereby accelerating the trend of increased morbidity. ... This dynamic is driven by a guaranteed issue market with rating constraints and an individual mandate penalty that continues to be far less than the cost of coverage for most individuals.

It's true that before Trump's election, insurance plans worried that the people signing up for coverage were sicker than they had expected and that enrollment numbers weren't as robust as forecasters had expected. It's also true that the uncertainty around the law's future — whether the administration will, for example, continue doing outreach around Obamacare enrollment — has exacerbated those concerns.

At this point, it seems fair to say that some part of the 2018 rate increases are due to the Trump administration and some part are due to the law itself. It seems clear to me that the Trump administration is making Obamacare more expensive, which I've written about at greater length here. Attributing a particular amount of the increase to Trump, however, is going to be awfully difficult, if not impossible.

A quick guide to following 2018 rate filings

There will be a lot of news stories in the next few months about the 2018 Obamacare premiums. This is a tough story to keep track of because there are 50 states that have 50 separate deadlines for turning in premiums! I wanted to highlight two resources that I think will be really useful for those who want to keep on top of the issue:

• Here's a calendar of when each state's 2018 rate filings are due. (Hat tip to Emily Gee, who flagged me to this document on Twitter.)

Charles Gaba's ACASignups site continues to be an invaluable resource for all things Obamacare. One thing I've found incredibly helpful on Charles's site is his calculations of the weighted average rate increase for each state. This takes into account how much enrollment each plan has, to give a better sense of how many people the big rate increases will actually hit.

Chart of the Day:

There are 10,000 safety net clinics across the country that provide contraceptives to low-income women. The Kaiser Family Foundation's new brief explores the role these play in America's reproductive health care system.

Kliff’s Notes

Your daily top health care reads, with research help from Caitlin Davis

Today's top news

• "Bipartisan health care talks pick up steam in Senate": "At least three moderate Democrats held an initial sit-down with half a dozen Republicans late Monday evening — the most tangible sign yet of centrists’ interest in finding common ground. The prospect of a bipartisan fix could chip away at GOP support for Majority Leader Mitch McConnell's plan to repeal Obamacare and endanger Minority Leader Chuck Schumer’s vow to maintain Democratic unity in opposition. But senators in both parties said their leaders knew about the meeting and made no moves to stop it." —Jennifer Haberkorn and Elena Schor, Politico
• "Senate GOP defends writing its health care bill in private": "[Senators] say it is unlikely that the bill will go through hearings and markups in committee, though they stress that a working group of lawmakers, as well as the entire Republican caucus, will have heavy input on the bill." —Peter Sullivan, the Hill
• "Price's remarks on opioid treatment were unscientific and damaging, experts say": "Addiction experts say that Price's remarks are consistent with widespread but inaccurate views on the use of buprenorphine and methadone, also known as opioid maintenance therapy. They worry that the secretary's comments perpetuate those views. 'It's not replacing one drug for another, because we define addiction based on behavior, not on the absence or presence of a drug,' says Waller." —Jake Harper, NPR
• "As states wage battles on high drug prices, drugmakers fight back": "Drugmakers oppose most of the bills, and have deployed officials and lobbyists to testify at legislative hearings and run advertising campaigns. The industry’s biggest lobbying group, Pharmaceutical Research and Manufacturers of America, says it is 'beefing up resources' to combat the state legislation." —Peter Loftus, Wall Street Journal

Longer reads and analysis

"Abortion is now an issue with no middle ground": "In order to win, the Republican and Democratic incumbents need to appeal to a broader spectrum of voters while still luring their base. And while there are moderate positions to be had on a whole host of issues, it’s difficult-to-impossible to find a politician who will articulate a nuanced position on abortion rights." —Paige Winfield Cunningham, Washington Post

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