Subsidies no longer in jeopardy
The Supreme Court ruled on June 25 that subsidies are legal in the federally-facilitated marketplace, and subsidies for 17,000 people in Wyoming will not disappear. If the Court had ruled that subsidies are only legal in state-run exchanges, coverage for many of those 17,000 Wyoming residents would likely have become unaffordable. The Kaiser Family Foundation estimated that their premiums would have increased an average of 340 percent if subsidies had been eliminated.
In addition, the loss of subsidies would have destabilized the entire individual market in states like Wyoming that rely on the federally-run exchange. The Robert Wood Johnson Foundation estimated that premiums would have risen by 55 percent next year, even for people who aren’t currently getting subsidies. And that doesn’t count the regular annual rate increases based on the rising cost of healthcare.
Fortunately, that is no longer a concern. Subsidies will continue to be available to new and existing enrollees in Wyoming’s exchange, and the individual health insurance market will remain operational.
Assuming that subsidies continue to be available and the individual market remains stable, only one individual exchange carrier has requested a rate increase of at least ten percent for 2016: WINhealth Partners has proposed a rate increase of 13.37 percent.
Healthcare.gov’s rate review tool only shows proposed rates that include double digit rate hikes, and the rest of the Wyoming plans that show up for 2016 are small group or off-exchange. Time Insurance is included in the list, but their parent company announced earlier this month that they will be exiting the individual market and not participating in the open enrollment that begins in November.
Wyoming is one of five states that leaves the rate review process up to HHS for ACA-compliant products, and rates have not yet been approved for 2016.
2015 enrollment data
The Wyoming exchange enrolled 21,092 people in private plans during the 2015 open enrollment period (through February 22, including the week-long extension). This is about a third of the exchange’s total target population.
HHS had set an enrollment projection of 15,000 people for Wyoming’s exchange by February 15, and ACAsignups predicted 19,000 people; the exchange easily surpassed both targets, and the total enrollment is 176% of what they had at the end of open enrollment last year.
Of the people who selected a plan during the 2015 open enrollment period, 48 percent are new to the exchange for 2015, and 91 percent are receiving premium subsidies.
An additional 847 people enrolleed in Medicaid or CHIP through the exchange between November 15 and February 22, qualifying under the state’s unchanged guidelines, as Wyoming has not expanded Medicaid under the ACA. Medicaid and CHIP enrollment continue year-round.
Open enrollment for 2015 has ended, although there’s a special enrollment period (March 15 to April 30) for people who didn’t know they would have to pay a penalty for being uninsured in 2014. Taking advantage of the special enrollment period gives people additional access to coverage, and allows them to avoid paying another – higher – penalty for all of 2015 as well. Otherwise, the only way you can purchase a plan for 2015 – on or off the exchange – is if you have a qualifying event. The next open enrollment period begins on November 1, but coverage won’t be effective until January 1, 2016.
As of January 9, Wyoming had the highest percentage increase in the country when comparing 2015 enrollment numbers with enrollment totals as of April 2014. On January 9, the 2015 enrollment count was 42 percent higher than the prior year’s total. By January 30, the growth over last year had increased to 54 percent – with two more weeks remaining in open enrollment.
ACA makes coverage affordable in Wyoming
Although Wyoming had the most expensive pre-subsidy health insurance premiums in the US in 2014, an HHS study released on June 18th demonstrates the power of the Obamacare tax credits, which are more substantial in Wyoming than in any of the other 35 states where HHS is running the exchange.
Even though Wyoming’s average pre-subsidy rates in 2014 came in at a whopping $536 per person, the average after-subsidy premiums paid by the 93% of Wyoming enrollees who qualify for subsidies is just $113.
Two other states (Arizona and West Virginia) also had average after-subsidy premiums of $113, despite the fact that their “retail” rates are considerably lower than Wyoming’s ($272 and $415, respectively). $113 is higher than the HHS-run marketplace average of $82, but it’s certainly far more affordable than the $536 that residents in sparsely-populated Wyoming would be paying without the Obamacare tax credits.
Wyoming carriers and rates
Rates have decreased in many areas of the country for people willing to switch plans for 2015, but that’s not the case in Wyoming. The NY Times Upshot pegs the increase in benchmark plan premiums in Wyoming at 7 percent or more, although the Kaiser Family Foundation shows the average benchmark plan in Wyoming increasing by just 1.6 percent for 2015.
Across all plans and metal levels in the exchange, a Commonwealth Fund analysis found that rates in Wyoming’s exchange are an average of 5 percent higher in 2015 for a 40 year-old non-smoker.
For people who qualify for subsidies however (which was 93 percent of the exchange enrollees in Wyoming in 2014, and 92 percent during the first month of the current open enrollment period), the state’s high health insurance premiums are dramatically offset by the premium tax credits, and that will continue to be the case in 2015. The average after-subsidy premium for the benchmark plans in Wyoming is expected to be $208 in 2015, a dollar less than it was in 2014.
The federally-run Wyoming health insurance exchange has 40 plans available (up from 18 last year) from two health insurance carriers: Blue Cross Blue Shield of Wyoming and WINHealth Partners, both of which participated in the exchange in 2014.
Prior to 2015 open enrollment, WINHealth had roughly 9,000 members in Wyoming, but their CEO said that they had added “thousands” of enrollees during the first month of open enrollment. Blue Cross Blue Shield of WY had about 2,000 enrollees at the end of open enrollment in 2014, and they had added 2,000 more enrollees in the first month this time around. Both carriers noted that things were much smoother in round two.
No longer the highest rates in the country
Rates in Wyoming were higher than anywhere else in the country in 2014, due to a variety of factors including a small number of insurers and a sparse, mostly rural population. Excluding Natrona and Laramie counties (home to Casper and Cheyenne), the rest of Wyoming ranked as the sixth most expensive region in the US for health insurance plans in 2014.
But a Kaiser Family Foundation analysis in November 2014 found that Burlington, Vermont and Anchorage, Alaska both have higher average pre-subsidy premiums for 2015 Bronze and Silver plans than Cheyenne, Wyoming (rates in the study were based on a 40 year old non-smoker).
No Medicaid expansion yet
Unfortunately for Wyoming residents living below the poverty line, the high cost of unsubsidized coverage means that the coverage gap is particularly harsh in Wyoming. Since the state has not expanded Medicaid under Obamacare, residents with incomes below 100% of poverty are not eligible for subsidies, and Medicaid is not available for most of them either.
Their only alternative is to pay full price for private insurance, which is particularly unrealistic in a state where the average premium is more than five hundred dollars a month.
Medicaid expansion could still come with time, but probably not in 2015. Governor Matt Mead has been discussing the issue with the federal government, and he noted in early November that HHS is “more open” to modified Medicaid expansion than they were in the past. Then in late November, the Governor released the details of his Medicaid expansion proposal, which would include modest premiums for enrollees with incomes between 100 percent and 138 percent of poverty, and along with small copays for many newly-eligible enrollees.
But lawmakers proposed a different plan (not vetted for budget neutrality or by HHS) and a Wyoming Senate committee approved a proposal that was essentially a combination of the two. The full Senate ultimately rejected the bill however, and Medicaid expansion is probably off the table for the 2015 legislative session.
While 70 percent of Wyoming residents disapprove of the ACA in general, 55 percent support Medicaid expansion according to a recent poll conducted by the University of Wyoming.
2014 enrollment numbers
The total private plan enrollment was the fourth lowest in the country, but Wyoming has the smallest population in the US.
An additional 2,216 exchange applicants had been found to be eligible for the state’s existing (not expanded) Medicaid or CHIP.
Originally, the federal projection was that Wyoming would have 13,000 private plan enrollees by March 31. That was revised to around 10,000, and officials were optimistic that a March surge in application volume would put total enrollment into the five figure range. That projection proved to be correct, and the exchange far surpassed the 10,000 mark by the end of the 2014 open enrollment window.
Wyoming exchange history
Gov. Matt Mead announced in late 2012 that Wyoming would default to the federal health insurance exchange for 2014, with the possibility of moving to a state-run exchange at some unspecified future date.
In 2012, the Wyoming legislature passed a bill requiring a small committee to study the federal government’s implementation and operation of the exchange. The committee will monitor how many state residents use the federal exchange, what problems they encounter, operating costs, and other factors in deciding whether to recommend the state eventually take over operations of the exchange.
The committee held its first meeting in April 2013, and the study may take more than two years according to the committee co-chair. This round of study continues the evaluation process started by the Wyoming Health Insurance Exchange Steering Committee, which Mead appointed in 2011.
Gov. Mead initially refused to expand Medicaid, but began supporting expansion as the year went on. Two bills that would expand Medicaid passed out of committee in January by a small margin. Both failed introduction during the budget session in mid-February, and the 2014 legislative session did not result in any further legislation on the issue.
In November 2014, Gov. Mead and the Health Department presented lawmakers with a modified Medicaid expansion proposal, and the governor asked them to approve it. Although a Senate committee approved a modified version of Mead’s proposal, the full senate rejected it in early February.
Wyoming health insurance exchange links
Wyoming Insurance Department
Provides consumer protection and support to Wyoming residents by investigating consumer complaints and resolving issues on insurance matters.
(307) 777-7401 / Toll Free: 1-800-438-5768 / firstname.lastname@example.org
State Exchange Profile: Wyoming
The Henry J. Kaiser Family Foundation overview of Wyoming’s progress toward creating a state health insurance exchange.