Thread by @charles_gaba

📣 EXCLUSIVE: MICHIGAN: 2018 #ACA MLR Rebate Payments (& potential 2019 rebates as well!):

acasignups.net/19/09/04/exclu…

I recently posted an explainer re. how the #ACA’s MLR provision works. Short version: Insurers have to spend at least 80-85% of premium revenue on actual medical expenses, leaving a 15-20% gross margin for operational costs/overhead and, yes, net profit.

acasignups.net/19/08/29/impor…

Over the past 7 years, the ACA has made carriers pay back nearly $4 billion in excessive premiums to policyholders, with around $1.3 billion going to individual market enrollees & the other $2.7 billion going towards the group (employer) market. 3/

For the #ACA individual market specifically, the amount of MLR rebates has ranged from as low as $102 million to as high as $400 million per year. 4/

THIS year, however....and especially next year...ACA individual market MLR rebates are expected to be higher for a variety of reasons...potentially MUCH higher. @KFF projected that it could be as much as $800 million this year:
kff.org/private-insura…

6/ My own VERY crude projections for NEXT year could potentially put it as high as $2.0 billion in #ACA MLR rebates, though it could be lower as well. The 2019 rebate checks will be going out right around 1 year from now...just ahead of the 2020 election. 6/

And no, Donald Trump does NOT get ANY credit for these rebate checks. They're part of the ACA itself...it was @alfranken who added the MLR clause to the ACA a decade ago. 7/

So what happened? Well, in 2017 the carriers understandably had the crap scared out of them by Trump/GOP's nonstop repeal/replace insanity & Trump admin sabotage. Insurers hate uncertainty above all else, so they jacked premiums thru the roof for 2018 (nearly 30% on avg). 8/

And this came after a 23% avg. rate hike in *2017* with the end of the federal ACA reinsurance program. At the same time, however, it turns out that by 2017, the ACA market premiums had already reached equilibrium, and carriers were starting to break even/turn a profit again. 9/

The rebate formula is based on a 3-year rolling average, so the 2017 payments included results from 2015, 2016 & 2017. Since 2015 & 2016 sucked, they dragged down the "OK" 2017 average. The 2018 payments will include 1 bad year (2016), 1 OK year (2017) & 1 good year (2018). 10/

The *2019* payments (which will go out in 2020) will include 1 OK year (2017), one good year (2018) & 1 VERY good year (2019), judging by the fact that 2020 premiums are expected to be virtually flat year over year. 11/
acasignups.net/rate-changes/2…

Now, all of this will vary GREATLY by state, by carrier and by year. And the "good year/bad year" rule varies as well. Some carriers won't pay out a dime; others will have to pay out tons of money. I'm starting out with Michigan because it's my home state. 12/

Here in Michigan, according to records from the Centers for Medicare & Medicaid, $3.3 million was paid out to 2017 enrollees last year...but only $40,000 will be paid out this year. NEXT year, however, this could POTENTIALLY balloon up to as much as a whopping $48 million. 13/

I'll be adding other states over the next few days. ⚠️ Please understand I have to first download HUNDREDS of spreadsheets, then cull them down to the appropriate data, then recompile that into another spreadsheet and then post it...for each state. So this will take awhile. 14/

📣 I *do* have one other state completed already, however: FLORIDA. From what I can tell, their 2018 indy market MLR rebates will be more than TRIPLE what they were last year...nearly $21 million total:

acasignups.net/19/09/04/exclu…