Effects of Implementing State Insurance Market Reform, 2011-2012. Percentage of Member-months Represented in Data

06/07/2013

The carriers represented by the filings captured in the database for this study in 2011 and 2012 represent more than half of national member-months in both markets (Table 8). In the individual market the filings from carriers constitute 65.1 percent of national member-months, including states not sampled, in 2011 and 68.9 percent of member-months in 2012. In the small group market the filings from carriers is 50.5 percent of national member-months, including states not sampled, in 2011 and 63.9 percent in 2012.

For the purpose of this study, state-level estimates are only considered reportable if the percentage of member-months represented for that state in the sample year is at least 50 percent using the weighted value of each filing. In 2011, there are eight states in the individual market that have less than 50 percent of member-months represented in the sample and three with no data available (see footnote to Table 8), but in 2012 there are only three states that do not meet the reportability threshold and one with no data available. In the small group market there are five states that have less than 50 percent of member-months represented in the 2011 sample year and seven with no data available, and four states that have less than 50 percent of member-months represented in the 2012 sample year and two with no data available. Additionally, state estimates based on a single filing are not reportable, regardless of the percentage of member months represented; the individual market in Arkansas in 2012 is the only case, in which over 50 percent of member-months are represented but the state-level estimate is not reportable.

For the individual market, California had 100 percent of its member-months represented for both 2011 and 2012. Four other states, Connecticut, Nevada, Oregon and Washington, had more than 90 percent of its member months represented in both years in the individual market. In the small group market, California and Washington had 100 percent of their member-months represented for both 2011 and 2012, and three other states including Florida, Kentucky, and Michigan all had greater than 90 percent of member months represented in both years.

Table 8: Percentage of Member-Months Included in the Sample by State for Individual and Small Group Markets, Trends Study (2008-2011) and SMR Study (2011-2012)

State* Individual & Conversion Trends 2008 Individual & Conversion Trends 2009 Individual & Conversion Trends 2010 Individual & Conversion Trends† 2011 Individual & Conversion SMR 2011 Individual & Conversion SMR 2012 State* Small Group Trends 2008 Small Group Trends 2009 Small Group Trends 2010 Small Group Trends 2011† Small Group SMR 2011 Small Group SMR 2012
Mean US 51.1% 70.6% 70.3% 63.9% 65.1% 68.9% Mean US 31.2% 46.1% 47.8% 55.8% 50.5% 63.9%
AL - **85.7% **85.7% **85.9% **87.9% **87.9% AL **95.7% **95.7% **96.3% **99.3% **91.6% 2.2%
AR 1.3% 11.8% 10.9% **81.0% **83.7% 77.2% AR - - - - - -
CA - 7.6% **91.3% **100.0% **100.0% **100.0% CA - 10.1% 10.1% **100.0% **100.0% **100.0%
CO 16.9% 46.1% **57.8% **54.8% **77.5% **86.6% CO 41.8% **94.5% **88.8% **94.0% **81.2% **89.4%
CT - **71.7% 35.6% **74.8% **96.1% **94.4% CT 8.5% - **64.3% 39.0% **63.7% **81.5%
DC         7.5% **69.0% DC         4.1% **65.4%
DE         44.8% - DE         - 7.5%
FL **67.2% **67.7% **78.0% **64.6% **75.4% **66.8% FL **65.3% **70.3% **72.0% **55.3% **99.5% **97.9%
HI - 46.8% - -     HI 82.3% 14.8% - 67.5%    
IA **91.9% **89.9% **84.8% **87.1% **83.7% **87.6% IA 0.1% - - 0.3% 12.2% 23.3%
ID 37.1% **71.5% **72.3% 33.9%     ID 42.6% 87.7% 43.0% 42.6%    
IL **72.4% **72.5% **72.1% - 1.5% **85.7% IL         **60.8% **73.1%
IN **92.9% **86.4% **73.8% 8.1% **67.4% **71.4% IN 0.8% **58.5% **62.4% **74.7% - -
KS - 19.1% 0.0%   7.1% **85.2% KS - 1.5% 1.4% 8.8% **77.9% **67.4%
KY **94.5% **94.5% **94.5% **95.1% 14.3% **91.4% KY **90.3% **95.5% **90.7% **95.4% **99.7% **100.0%
MA             MA       26.5%    
MD 1.9% 3.7% 27.6% **72.2%     MD 6.0% **61.5% **77.7% **68.5%    
ME 49.9% **50.2% **98.4% **98.6% **92.7% **58.4% ME - 0.0% 7.5% **71.4% **91.1% **89.6%
MI 1.8% 1.8% 0.0% 1.0% **65.7% 12.8% MI         **93.4% **100.0%
MN 9.6% **83.3% **83.4% **83.3% - **87.7% MN 7.1% 0.4% **84.4% **54.8% - **61.2%
NC 9.7% 12.1% **84.6% **89.7% **87.4% **87.4% NC **63.4% **63.9% **63.3% **69.5% **74.5% **74.5%
NE - 62.7% **62.8% **69.5% 1.1% **87.0% NE - - 42.0% 37.3% 22.1% 28.1%
NJ - **80.9% **81.8% **81.8% - **71.4% NJ **86.2% **84.0% **86.2% **79.5% - **64.0%
NV         **96.6% **96.6% NV         **61.5% **73.7%
NY         25.2% **72.0% NY         **84.7% **83.0%
OH 1.8% 1.8% 41.8% 39.2%     OH - 6.5% **66.4% **68.6%    
OK 4.2% **62.8% **62.8% **62.8% **71.3% **84.5% OK         37.2% **86.4%
OR **83.0% **99.2% **96.0% **89.7% **92.5% **90.1% OR **65.0% **100.0% **99.9% **99.5% **98.9% **77.7%
PA 39.5% 47.7% **62.3% **54.7% **59.2% **68.8% PA 12.9% 1.1% 1.1% 6.8% - **74.2%
RI 0.5% 47.8% 47.3% 47.3% - 48.4% RI - - **70.7% **71.2% - **87.6%
SD 5.1% **86.3% **87.6%       SD            
TN         12.7% **55.9% TN         **71.9% **72.5%
VA - **73.2% **77.0% 0.5% **81.8% **84.6% VA - 0.0% **54.9% **57.6% **73.6% **71.4%
WA 43.2% 9.7% **100.0% **87.2% **91.7% **91.7% WA - 13.0% **71.0% 24.1% **100.0% **100.0%
WI **80.8% **79.3% **77.4% **50.3% **66.5% **55.5% WI - - - 0.0% 4.6% **96.1%

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

Note: State estimates highlighted in blue** are reportable. State estimates containing only one filing, no matter its enrollment, are not considered reportable.

* The Trends study did not include DC, DE, NV, NY and TN in the state sample, so these cells are left blank for the Trends columns. This report does not include HI, ID, MA, MD, OH and SD in the state sample, so these cells are left blank for the SMR columns. Missing values for states included in the study are denoted with a dash.

Tables 9 and 10 present the percent of national member-months represented in the study by state regulatory review authority for the individual and small group markets. As noted earlier, states’ regulatory approval authority is classified in three ways: “prior approval,” “file and use,” or “other.” In the Trends study, states were classified as “prior approval,” “file and use,” or “HMO prior approval.”31 Many states have recently become more transparent and have provided more detail about their regulatory review authority. This new information was taken into account when classifying states’ regulatory authority for the current study (as seen in Table 1). The “other” category in this study includes states that have prior approval authority only for HMO plans (such as Alabama), but also includes states with other types of authority, including Virginia, which is has prior approval authority except for HMOs, which may file and use rate changes.

As with the Trends study, “prior approval” states accounted for the greatest share of national enrollment from our filings in both 2011 and 2012. In 2011, filings in our database from “prior approval” states constituted 42.5 percent of the national member-months in the individual market and 33.2 percent in the small group market, whereas filings from “file and use” states accounted for 16.2 percent of national enrollment in the individual market and 13.2 percent of national enrollment in the small group market. In 2012, filings in our database in “prior approval” states constituted 45.2 percent of national membermonths in the individual market and 35.4 percent in the small group market, whereas filings from “file and use” states accounted for 16.0 percent of national enrollment in the individual market and 13.5 percent in the small group market.

Table 9: Percent of National Member-Months Represented in the Sample, by Rate Regulatory Review for the Individual/Conversion Market

State Regulatory Status Trends 2008 Trends 2009 Trends 2010 Trends 2011† SMR 2011 SMR 2012
Total 51.1% 70.6% 70.3% 63.9% 65.1% 68.9%
File and Use 7.6% 20.1% 20.1% 15.6% 16.2% 16.0%
Prior Approval 42.4% 49.0% 49.0% 47.1% 42.5% 45.2%
HMO Prior Approval 1.2% 1.5% 1.2% 1.2% NA NA
Other N/A N/A N/A N/A 6.4% 7.6%

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

N/A = Not available

Table 10: Percent of National Member-Months Represented in the Sample, by Rate Regulatory Review for the Small Group Market

State Regulatory Status Trends 2008 Trends 2009 Trends 2010 Trends 2011† SMR 2011 SMR 2012
Total 31.2% 46.1% 47.8% 55.8% 50.5% 63.9%
File and Use 2.4% 9.4% 10.0% 12.1% 13.2% 13.5%
Prior Approval 27.4% 29.4% 29.9% 34.8% 33.2% 35.4%
HMO Prior Approval 4.4% 7.3% 7.9% 8.9% N/A N/A
Other N/A N/A N/A N/A 4.0% 15.0%

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

N/A = Not available

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