Effects of Implementing State Insurance Market Reform, 2011-2012. Availability of Enrollment Data in Filings

06/07/2013

Enrollment information was captured in filings in three ways: the reported number of covered lives, the number of member-months covered by the plan, and the number of group contracts. If a filing contained any of these three pieces of information, we considered it to have enrollment data present; adjustments made during the weighting process detailed in this report’s Methods section facilitated comparison of different measures of enrollment. Table 11 presents the number and percentage of filings with enrollment data.

Among all filings in the database, the percentage of filings that included enrollment data increased over the two years included in this study (Table 11). In the individual market, this percentage increased from 76.6 percent in 2011 to 84.6 percent in 2012. In the small group market, corresponding figures increased from 78.3 percent to 88.0 percent.

Table 11: Number and Percentage of Filings with Enrollment Data, by Market and Year

  Market Trends 2008 Trends 2009 Trends 2010 Trends 2011† Trends Total 2008- 2011† SMR 2011 SMR 2012 SMR Total 2011- 2012
Number of Filings with Enrollment Data Individual 183 348 408 357 1296 278 334 612
Small Group 116 150 227 287 780 256 501 757
Percentage of Filings with Enrollment Data Individual 50.1% 64.4% 71.2% 80.0% 67.4% 76.6% 84.6% 80.7%
Small Group 83.5% 85.7% 86.3% 92.9% 88.0% 78.3% 88.0% 84.5%

† Trends data for 2011 are incomplete (see Methods section).

Filingssubmitted through SERFF have several standardized options to indicate their status – in prior approval states, the most common of these are “approved” and “disapproved,” while in file and use states, most are labeled “filed.” In some cases, however, data were ambiguous: some filings from prior approval states are labeled “filed,” and a few filings have unusual labels including “acknowledged,” “closed,” or “received.” We believe that, for this former group labeled “filed”, the state regulator may not have issued a final determination, allowing the carrier to implement the rate increase under “deemer” rules.32 For the purposes of our analysis, acknowledged and closed filings are considered “filed”; in addition to approved, disapproved, and filed, we also categorized filings as “withdrawn” (by the carrier without being enacted) or “pending” (still under state review at the time of data collection). Some filings had no information about filing status. In both the individual and small group markets, file and use and “other” states were dominated by filings with the status of “filed”, which tells us little about state review. As a result, in assessing the quality of data on filing disposition status, we feel the most meaningful analysis is limited to prior approval states. In this section, we consider the prevalence of filings with a “finalized” disposition – those labeled approved, disapproved, or withdrawn – as compared to those with “incomplete” dispositions – labeled filed, pending, or missing a value for approval status. Later in the Findings section of this report, our analysis of Approval Rates of State Regulators compares the prevalence of filings labeled approved or filed to those with another status (see Tables 24-30).

Table 12 presents the number and percentage of filings that had finalized approval status (approved, disapproved or withdrawn) among all filings from states with prior approval authority. In the individual group market the percentage of filings with a finalized approval status decreased slightly from 2011 to 2012 (86.7 percent to 82.3 percent, respectively). In the small group market, the percentage of filings with finalized approval status increased slightly across the two-year study period, at 81.8 percent in 2011 and 85.7 percent in 2012. All file and use states are excluded from this table.

Table 12: Number and Percentage of Filings with Finalized Approval Status‡ in States with Regulator Prior Approval, by Market and Year

  Market Trends 2008 Trends 2009 Trends 2010 Trends 2011† Trends Total 2008- 2011† SMR 2011 SMR 2012 Total 2011- 2012
Number of Filings with Data on Approval Status Individual 213 349 365 311 1238 215 232 447
Small Group 102 130 181 161 574 171 234 405
Percentage of Filings with Data on Approval Status Individual 86.6% 93.1% 87.7% 86.9% 88.7% 86.7% 82.3% 84.3%
Small Group 78.5% 82.3% 84.6% 71.2% 78.8% 81.8% 85.7% 84.0%

† Trends data for 2011 are incomplete (see Methods section).

‡ As described above, “finalized approval status” refers to filings which are considered approved, disapproved, or withdrawn by the carrier.

Table 13 presents the number and percentage of filings that had grandfathered status. Provisions in the ACA allowed for insurance plans that already existed on March 23, 2010 to retain a “grandfathered” status. This status means that these health plans do not have to meet all the requirements such as providing certain recommended preventive services at no additional charge to the consumer, or offering protections when a consumer appeals claims and coverage denials. Other requirements of the ACA still apply to all plans regardless of grandfathered status. Examples of these requirements include the provision that prohibits plans from applying a lifetime dollar limit to key health benefits and the requirement that health care coverage must be extended to dependent adult children until the age of 26. 33

In the individual group market the percentage of filings with information on whether the plan had grandfathered status decreased slightly from 2011 to 2012 (60.1 percent to 58.2 percent, respectively). In the small group market, the percentage of filings with information on grandfathered status increased from 27.2 percent in 2011 to 50.6 percent in 2012. As nearly half of the filings in the individual market and more than half of the filings in the small group market are missing any information on grandfathered status, additional analyses to compare grandfathered versus non-grandfathered plan were not conducted.

Table 13: Number and Percentage of Filings with Grandfathered Status, by Market and Year

  Market SMR 2011 SMR 2012 Total 2011-2012
Number of Filings with Data on Grandfathered Status Individual 218 230 448
Small Group 89 288 377
Percentage of Filings with Data on Grandfathered Status Individual 60.1% 58.2% 59.1%
Small Group 27.2% 50.6% 42.1%

32 Some prior approval states have a “deemer” clause. If the state has not acted on the carrier’s rate request, that request goes into effect 30, 60, or 90 days after the insurer files its request, depending upon the state law. In the rate filings, the designated status is occasionally “closed” or “filed”, but never “deemed”. Some of the rate filings with no disposition may have been settled under “deemer” rules.

33 Department of Health and Human Services. “Grandfathered Health Plans” 2012 August. Available at http://www.healthcare.gov/law/features/rights/grandfathered-plans/index..... Accessed 10 May 2013.

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