AI
Friday, May 20, 2011 6:24:41 AM
Insurers Told to Justify Rate Increases Over 10 Percent
Kathleen Sebelius, the secretary of health and human services, issued a rule Thursday on procedures for reviews of premiums.
Alex Wong/Getty Images
By ROBERT PEAR
Published: May 19, 2011
WASHINGTON — Alarmed at soaring premiums and profits in the health insurance industry, the Obama administration demanded on Thursday that insurers justify proposed rate increases of more than 10 percent, starting in September.
“Health insurance companies have recently reported some of their highest profits in years and are holding record reserves,” Ms. Sebelius said. “Insurers are seeing lower medical costs as people put off care and treatment in a recovering economy, but many insurance companies continue to raise their rates. Often, these increases come without any explanation or justification.”
Federal health officials proposed the 10 percent threshold in December. The insurance industry criticized it as an arbitrary test that could brand a majority of rate increases as presumptively unreasonable. But the administration rejected the criticism and insisted on the 10 percent standard in the final rule, issued Thursday.
Starting in September 2012, the federal government will set a separate threshold for each state, reflecting trends in insurance and health care costs.
In some states like New Hampshire, groups of more than 20 workers have experienced premium increases of around 20 percent this year, while smaller groups have seen increases of 40 percent or more. At the same time, insurance agents say, coverage is shrinking as deductibles have increased and insurers limit the choice of hospitals.
To ensure that “consumers get value for their dollars,” the new health care law required annual reviews of “unreasonable increases in premiums.”
Under the new rule, federal and state officials will review rates in the individual and small-group insurance markets. In effect, the administration said, large employers can take care of themselves, as they are more sophisticated purchasers and have more leverage in negotiating with insurers.
Federal officials acknowledged that they did not have the authority to block rates that were found to be unjustified. But they said many states had such authority, and the federal government is providing $250 million to states to strengthen their capacity. A small number of states, opposed to the federal health care law, have turned down the money.
The new rule says a rate increase is unreasonable if it is excessive, unjustified or “unfairly discriminatory.” An increase is deemed excessive if it is “unreasonably high in relation to the benefits provided.”
Consumer advocates generally welcomed the rule. “The days of insurance companies running roughshod over consumers and jacking up rates whenever they want are over,” said Ethan S. Rome, executive director of Health Care for America Now [ http://healthcareforamericanow.org/ ], a coalition that includes labor unions and civil rights groups.
Insurers said the rule did nothing to address the underlying costs of health care, which they described as the main factor driving up premiums.
“If we believe health care costs are crushing the economy, we ought to have a debate about how to bring costs under control,” said Karen M. Ignagni, president of America’s Health Insurance Plans, a trade group. “Focusing on premiums diverts attention from that debate.”
In many cases, Ms. Ignagni said, rate increases of more than 10 percent may be justified by rising health costs and the tendency of younger, healthier people to drop coverage, forcing up costs for other policyholders.
States will have the primary responsibility for reviewing rate increases. “But if a state does not have the authority or the resources to conduct a review, our department will step in,” said Ms. Sebelius, a former state insurance commissioner in Kansas.
Under the rule, as part of an effective rate review program, states must have “a mechanism for receiving public comments” on proposed rate increases.
Elizabeth P. Sammis, the acting insurance commissioner in Maryland, said this would be a big change. In many cases, she said, consumers learn of premium increases when they receive notices in the mail, and then they call the commissioner’s office to ask, “Why are rates going up?”
© 2011 The New York Times Company
http://www.nytimes.com/2011/05/20/us/politics/20health.html
===
Health Insurers Lose Push to Ease Rule on U.S. Overhaul Law’s Price Review
By Drew Armstrong - May 19, 2011 1:26 PM CT
U.S. insurers led by WellPoint Inc. (WLP) and UnitedHealth Group Inc. (UNH) failed to get federal regulators to change a rule in the 2010 health-care overhaul that triggers a review of any premium increases exceeding 10 percent.
The ruling takes effect this year and adds pressure on insurers to justify price increases. The health insurance industry’s Washington lobbying group, America’s Health Insurance Plan had asked the government to do away with the 10 percent rate review threshold, calling it flawed.
The rules were prompted partly by a proposal from the California subsidiary of Indianapolis-based WellPoint to raise rates as much as 39 percent in 2010. After a review by California’s insurance commissioner, the underlying calculations were found to be incorrect and WellPoint cut the increase in half, according to the Department of Health and Human Services.
“Effective rate review works,” said Kathleen Sebelius, the U.S. Secretary of Health and Human Services, in a statement announcing the rules. “It does so by protecting consumers from unreasonable rate increases and bringing needed transparency to the marketplace.”
Insurance exchanges set up by the health-care overhaul will offer tax credits for Americans to buy private coverage by 2019. Starting this year, insurers are to provide state and federal regulators with justification for any premium increases of 10 percent or more.
Subject to Reviews
Insurers are subject to the reviews starting on Sept. 1, the government said in announcing the process. In September 2012, the U.S. will set up new price thresholds for state-by- state review to replace the 10 percent benchmark.
Karen Ignagni, the America’s Health Insurance Plan chief executive officer, said policymakers should focus on lowering underlying medical costs such as hospitals, doctors, technology, and drug prices.
“Health plans are doing their part to restrain health-care cost growth by partnering with providers across the country to change payment models to promote and reward safe, high-quality, cost-effective care,” Ignagni said in a statement.
To contact the reporter on this story: Drew Armstrong in Washington at darmstrong17@bloomberg.net;
To contact the editor responsible for this story: Adriel Bettelheim at abettelheim@bloomberg.net.
©2011 BLOOMBERG L.P.
http://www.bloomberg.com/news/2011-05-19/health-insurers-lose-push-to-ease-rule-on-u-s-overhaul-law-s-price-review.html
===
Health Insurance Rate Hikes Face Tougher Scrutiny
By Julie Appleby
KHN Staff Writer
May 19, 2011
Health insurers seeking rate increases of 10 percent or more will face increased scrutiny starting in September under rules finalized Thursday [ http://www.ofr.gov/OFRUpload/OFRData/2011-12631_PI.pdf ] by the Obama Administration.
States – or in some cases the federal government – will review the flagged premium increases and insurers will have to justify increases deemed unreasonable. The law does not give the federal government power to reject increases, but many state regulators have that authority.
The rules, required by the health care law enacted last year, also require insurers to provide a broad overview of what they plan to spend the money on, including how much would go to medical services, profits and administrative costs [ http://www.kaiserhealthnews.org/~/media/Files/2011/CMS10379Consumer%20Disclosure%20Template.pdf ].
“Recently, insurers have posted some of their highest profits in years … and (yet) they continue to raise rates, often without any explanation or justification,” Health and Human Services Secretary Kathleen Sebelius said in a conference call with reporters. “The framework of the Affordable Care Act is beginning to change this.”
The rules are nearly identical to the proposal issued by HHS in December and come amid continued concern about rapidly rising insurance costs. Such increases have come even as many insurers have seen their costs slow as economically strapped consumers cut back on medical care. Insurers criticized the rules.
“Focusing on health insurance premiums while ignoring underlying medical cost drivers will not make health care coverage more affordable for families and employers,” said Karen Ignagni, head of America’s Health Insurance Plans, in a written statement.
“Premium review must adequately factor in all of the components that determine premium rates,” Ignagni added, “including geographic variation, the cost of new benefit mandates, and the impact of younger and healthier people dropping coverage.”
Under the final rule, the 10 percent threshold will be in effect for rate hikes starting Sept. 1 – two months later than originally proposed. But in subsequent years, state-specific thresholds will be developed by the states in conjunction with HHS, reflecting local market conditions.
Consumer groups were generally supportive, with Ethan Rome of the left-leaning Health Care for America Now saying it puts insurers on notice that “unjustified, double-digit premium rate increases will not be tolerated.”
Only insurance policies sold to individuals and small businesses – not those offered to large employers -- are affected by the new rules. Administration officials said they will seek additional comments on whether the rules should be expanded to so-called “association health plans,” which are sold to individuals and small businesses, but are pooled together in large groups.
Timothy Jost, a professor at Washington and Lee University School of Law, said he is disappointed that the rules do not include association health plans.
“That’s a huge loophole and an easy way for health plans to avoid scrutiny,” said Jost.
Some consumer groups also took issue with the 10 percent standard, saying the rule needed a secondary “trigger” – such as increases that go beyond medical cost inflation.
Without such a second option for review, the regulation could “lock in a 9.9 percent increase as the de facto “reasonable” rate,” the advocacy group Consumer Watchdog warned in a letter to HHS.
The group also said the rules allow states to keep private from consumers more in-depth financial details from insurers – information advocates say people need to make their own judgments about rate increases.
“The actual data backing up insurers’ claims will still be private in many states and the public will have no ability to question those assumptions,” said Carmen Balber, director of Consumer Watchdog’s Washington office.
Under the rules, states with “effective” rate review systems will do their own reviews of the increases. To be considered effective, states must show they collect data sufficient to determine whether a rate increase is unreasonable and allow for public comment about the increase.
If a state can’t do an effective review, HHS would do it for them.
The law does not give the federal government the ability to reject increases. That power rests with the states. According to the National Conference of State Legislatures, about two dozen states have laws [ http://www.ncsl.org/default.aspx?tabid=19787 ] allowing regulators to approve or disapprove of some types of insurance premium changes, although how the authority is used varies widely.
In recent months, some state regulators have sought reductions. In Rhode Island, the insurance commissioner lowered a requested 7.9 percent increase to 1.9 percent. After North Dakota policyholders complained, a proposed 24 percent increase was lowered to 14 percent in April.
In the past year, some insurers in California withdrew double-digit increases after regulators found mathematical errors in the companies’ calculations. But another insurer, Anthem, this month moved ahead with increases of up to 16 percent, even after the increase was deemed unreasonable. Regulators there don’t have authority to reject increases, but are seeking legislative authority to do so.
jappleby@kff.org
All original KHN material – articles, graphics and videos – can be used for free, if you credit us and link to us.
http://www.kaiserhealthnews.org/Stories/2011/May/19/insurance-rate-increases-aca-rules.aspx
===
Double-Digit Insurance Rate Increases Get More Scrutiny
By REED ABELSON
May 19, 2011, 2:03 pm
Federal officials announced new rules on Thursday that require health insurers that decide to raise their rates sharply to provide more justification for the higher premiums.
“We know increased scrutiny works,” said Secretary Kathleen Sebelius, of health and human services, in making Thursday’s announcement [ http://www.hhs.gov/news/press/2011pres/05/20110519a.html ]. She cited several recent examples of state regulators, in places like Rhode Island and North Dakota, being able to pressure health insurers to reduce their proposed increases.
The federal health care law requires states to review large rate requests, and the new regulation sets the threshold for review at 10 percent, beginning Sept. 1. Federal officials eventually plan to establish different thresholds for different states. Federal regulators can conduct the reviews if state insurance regulators do not.
The new rule is going into effect as insurers are announcing record profits and flush reserves. In a front-page article [ http://www.nytimes.com/2011/05/14/business/14health.html (first item, two posts back at http://investorshub.advfn.com/boards/read_msg.aspx?message_id=63121962 )] in The Times last week, the sizable gains were linked to how people have been delaying or forgoing care, even as insurers have still been raising premiums. They claim they expect health care costs to go up, once people start to go to the doctor when they feel as if they have more money in their pockets.
“Focusing on health insurance premiums while ignoring underlying medical cost drivers will not make health care coverage more affordable for families and employers,” said Karen Ignagni, the chief executive of America’s Health Insurance Plans, a trade group, in a statement responding to the new rule.
She also warned against “an arbitrary threshold for review” that may not adequately take into account the complicated array of factors that determine premium rates.
While the new rule does not give states or the federal government new authority to reject rates before they go into effect, it forces insurers to explain the reasons behind any double-digit increases, according to federal officials. The rule only applies to policies offered to individuals or small businesses because large employers buying coverage for their workers tend to be more sophisticated purchasers, and some states may not have the authority to review premiums for large groups.
Federal officials emphasized that a key aspect of the new rule is the requirement that insurers publicly show their work on the federal government’s Web site and on their own. While some states have the authority to reject rates before they go into effect, the law relies more on increased scrutiny to pressure insurers to keep rates in check.
How effective do you think making insurers publicly justify large rate increases will be in keeping a lid on double-digit premium increases?
© 2011 The New York Times Company
http://prescriptions.blogs.nytimes.com/2011/05/19/double-digit-insurance-rate-increases-get-more-scrutiny/ [no comments yet]
Kathleen Sebelius, the secretary of health and human services, issued a rule Thursday on procedures for reviews of premiums.
Alex Wong/Getty Images
By ROBERT PEAR
Published: May 19, 2011
WASHINGTON — Alarmed at soaring premiums and profits in the health insurance industry, the Obama administration demanded on Thursday that insurers justify proposed rate increases of more than 10 percent, starting in September.
“Health insurance companies have recently reported some of their highest profits in years and are holding record reserves,” Ms. Sebelius said. “Insurers are seeing lower medical costs as people put off care and treatment in a recovering economy, but many insurance companies continue to raise their rates. Often, these increases come without any explanation or justification.”
Federal health officials proposed the 10 percent threshold in December. The insurance industry criticized it as an arbitrary test that could brand a majority of rate increases as presumptively unreasonable. But the administration rejected the criticism and insisted on the 10 percent standard in the final rule, issued Thursday.
Starting in September 2012, the federal government will set a separate threshold for each state, reflecting trends in insurance and health care costs.
In some states like New Hampshire, groups of more than 20 workers have experienced premium increases of around 20 percent this year, while smaller groups have seen increases of 40 percent or more. At the same time, insurance agents say, coverage is shrinking as deductibles have increased and insurers limit the choice of hospitals.
To ensure that “consumers get value for their dollars,” the new health care law required annual reviews of “unreasonable increases in premiums.”
Under the new rule, federal and state officials will review rates in the individual and small-group insurance markets. In effect, the administration said, large employers can take care of themselves, as they are more sophisticated purchasers and have more leverage in negotiating with insurers.
Federal officials acknowledged that they did not have the authority to block rates that were found to be unjustified. But they said many states had such authority, and the federal government is providing $250 million to states to strengthen their capacity. A small number of states, opposed to the federal health care law, have turned down the money.
The new rule says a rate increase is unreasonable if it is excessive, unjustified or “unfairly discriminatory.” An increase is deemed excessive if it is “unreasonably high in relation to the benefits provided.”
Consumer advocates generally welcomed the rule. “The days of insurance companies running roughshod over consumers and jacking up rates whenever they want are over,” said Ethan S. Rome, executive director of Health Care for America Now [ http://healthcareforamericanow.org/ ], a coalition that includes labor unions and civil rights groups.
Insurers said the rule did nothing to address the underlying costs of health care, which they described as the main factor driving up premiums.
“If we believe health care costs are crushing the economy, we ought to have a debate about how to bring costs under control,” said Karen M. Ignagni, president of America’s Health Insurance Plans, a trade group. “Focusing on premiums diverts attention from that debate.”
In many cases, Ms. Ignagni said, rate increases of more than 10 percent may be justified by rising health costs and the tendency of younger, healthier people to drop coverage, forcing up costs for other policyholders.
States will have the primary responsibility for reviewing rate increases. “But if a state does not have the authority or the resources to conduct a review, our department will step in,” said Ms. Sebelius, a former state insurance commissioner in Kansas.
Under the rule, as part of an effective rate review program, states must have “a mechanism for receiving public comments” on proposed rate increases.
Elizabeth P. Sammis, the acting insurance commissioner in Maryland, said this would be a big change. In many cases, she said, consumers learn of premium increases when they receive notices in the mail, and then they call the commissioner’s office to ask, “Why are rates going up?”
© 2011 The New York Times Company
http://www.nytimes.com/2011/05/20/us/politics/20health.html
===
Health Insurers Lose Push to Ease Rule on U.S. Overhaul Law’s Price Review
By Drew Armstrong - May 19, 2011 1:26 PM CT
U.S. insurers led by WellPoint Inc. (WLP) and UnitedHealth Group Inc. (UNH) failed to get federal regulators to change a rule in the 2010 health-care overhaul that triggers a review of any premium increases exceeding 10 percent.
The ruling takes effect this year and adds pressure on insurers to justify price increases. The health insurance industry’s Washington lobbying group, America’s Health Insurance Plan had asked the government to do away with the 10 percent rate review threshold, calling it flawed.
The rules were prompted partly by a proposal from the California subsidiary of Indianapolis-based WellPoint to raise rates as much as 39 percent in 2010. After a review by California’s insurance commissioner, the underlying calculations were found to be incorrect and WellPoint cut the increase in half, according to the Department of Health and Human Services.
“Effective rate review works,” said Kathleen Sebelius, the U.S. Secretary of Health and Human Services, in a statement announcing the rules. “It does so by protecting consumers from unreasonable rate increases and bringing needed transparency to the marketplace.”
Insurance exchanges set up by the health-care overhaul will offer tax credits for Americans to buy private coverage by 2019. Starting this year, insurers are to provide state and federal regulators with justification for any premium increases of 10 percent or more.
Subject to Reviews
Insurers are subject to the reviews starting on Sept. 1, the government said in announcing the process. In September 2012, the U.S. will set up new price thresholds for state-by- state review to replace the 10 percent benchmark.
Karen Ignagni, the America’s Health Insurance Plan chief executive officer, said policymakers should focus on lowering underlying medical costs such as hospitals, doctors, technology, and drug prices.
“Health plans are doing their part to restrain health-care cost growth by partnering with providers across the country to change payment models to promote and reward safe, high-quality, cost-effective care,” Ignagni said in a statement.
To contact the reporter on this story: Drew Armstrong in Washington at darmstrong17@bloomberg.net;
To contact the editor responsible for this story: Adriel Bettelheim at abettelheim@bloomberg.net.
©2011 BLOOMBERG L.P.
http://www.bloomberg.com/news/2011-05-19/health-insurers-lose-push-to-ease-rule-on-u-s-overhaul-law-s-price-review.html
===
Health Insurance Rate Hikes Face Tougher Scrutiny
By Julie Appleby
KHN Staff Writer
May 19, 2011
Health insurers seeking rate increases of 10 percent or more will face increased scrutiny starting in September under rules finalized Thursday [ http://www.ofr.gov/OFRUpload/OFRData/2011-12631_PI.pdf ] by the Obama Administration.
States – or in some cases the federal government – will review the flagged premium increases and insurers will have to justify increases deemed unreasonable. The law does not give the federal government power to reject increases, but many state regulators have that authority.
The rules, required by the health care law enacted last year, also require insurers to provide a broad overview of what they plan to spend the money on, including how much would go to medical services, profits and administrative costs [ http://www.kaiserhealthnews.org/~/media/Files/2011/CMS10379Consumer%20Disclosure%20Template.pdf ].
“Recently, insurers have posted some of their highest profits in years … and (yet) they continue to raise rates, often without any explanation or justification,” Health and Human Services Secretary Kathleen Sebelius said in a conference call with reporters. “The framework of the Affordable Care Act is beginning to change this.”
The rules are nearly identical to the proposal issued by HHS in December and come amid continued concern about rapidly rising insurance costs. Such increases have come even as many insurers have seen their costs slow as economically strapped consumers cut back on medical care. Insurers criticized the rules.
“Focusing on health insurance premiums while ignoring underlying medical cost drivers will not make health care coverage more affordable for families and employers,” said Karen Ignagni, head of America’s Health Insurance Plans, in a written statement.
“Premium review must adequately factor in all of the components that determine premium rates,” Ignagni added, “including geographic variation, the cost of new benefit mandates, and the impact of younger and healthier people dropping coverage.”
Under the final rule, the 10 percent threshold will be in effect for rate hikes starting Sept. 1 – two months later than originally proposed. But in subsequent years, state-specific thresholds will be developed by the states in conjunction with HHS, reflecting local market conditions.
Consumer groups were generally supportive, with Ethan Rome of the left-leaning Health Care for America Now saying it puts insurers on notice that “unjustified, double-digit premium rate increases will not be tolerated.”
Only insurance policies sold to individuals and small businesses – not those offered to large employers -- are affected by the new rules. Administration officials said they will seek additional comments on whether the rules should be expanded to so-called “association health plans,” which are sold to individuals and small businesses, but are pooled together in large groups.
Timothy Jost, a professor at Washington and Lee University School of Law, said he is disappointed that the rules do not include association health plans.
“That’s a huge loophole and an easy way for health plans to avoid scrutiny,” said Jost.
Some consumer groups also took issue with the 10 percent standard, saying the rule needed a secondary “trigger” – such as increases that go beyond medical cost inflation.
Without such a second option for review, the regulation could “lock in a 9.9 percent increase as the de facto “reasonable” rate,” the advocacy group Consumer Watchdog warned in a letter to HHS.
The group also said the rules allow states to keep private from consumers more in-depth financial details from insurers – information advocates say people need to make their own judgments about rate increases.
“The actual data backing up insurers’ claims will still be private in many states and the public will have no ability to question those assumptions,” said Carmen Balber, director of Consumer Watchdog’s Washington office.
Under the rules, states with “effective” rate review systems will do their own reviews of the increases. To be considered effective, states must show they collect data sufficient to determine whether a rate increase is unreasonable and allow for public comment about the increase.
If a state can’t do an effective review, HHS would do it for them.
The law does not give the federal government the ability to reject increases. That power rests with the states. According to the National Conference of State Legislatures, about two dozen states have laws [ http://www.ncsl.org/default.aspx?tabid=19787 ] allowing regulators to approve or disapprove of some types of insurance premium changes, although how the authority is used varies widely.
In recent months, some state regulators have sought reductions. In Rhode Island, the insurance commissioner lowered a requested 7.9 percent increase to 1.9 percent. After North Dakota policyholders complained, a proposed 24 percent increase was lowered to 14 percent in April.
In the past year, some insurers in California withdrew double-digit increases after regulators found mathematical errors in the companies’ calculations. But another insurer, Anthem, this month moved ahead with increases of up to 16 percent, even after the increase was deemed unreasonable. Regulators there don’t have authority to reject increases, but are seeking legislative authority to do so.
jappleby@kff.org
All original KHN material – articles, graphics and videos – can be used for free, if you credit us and link to us.
http://www.kaiserhealthnews.org/Stories/2011/May/19/insurance-rate-increases-aca-rules.aspx
===
Double-Digit Insurance Rate Increases Get More Scrutiny
By REED ABELSON
May 19, 2011, 2:03 pm
Federal officials announced new rules on Thursday that require health insurers that decide to raise their rates sharply to provide more justification for the higher premiums.
“We know increased scrutiny works,” said Secretary Kathleen Sebelius, of health and human services, in making Thursday’s announcement [ http://www.hhs.gov/news/press/2011pres/05/20110519a.html ]. She cited several recent examples of state regulators, in places like Rhode Island and North Dakota, being able to pressure health insurers to reduce their proposed increases.
The federal health care law requires states to review large rate requests, and the new regulation sets the threshold for review at 10 percent, beginning Sept. 1. Federal officials eventually plan to establish different thresholds for different states. Federal regulators can conduct the reviews if state insurance regulators do not.
The new rule is going into effect as insurers are announcing record profits and flush reserves. In a front-page article [ http://www.nytimes.com/2011/05/14/business/14health.html (first item, two posts back at http://investorshub.advfn.com/boards/read_msg.aspx?message_id=63121962 )] in The Times last week, the sizable gains were linked to how people have been delaying or forgoing care, even as insurers have still been raising premiums. They claim they expect health care costs to go up, once people start to go to the doctor when they feel as if they have more money in their pockets.
“Focusing on health insurance premiums while ignoring underlying medical cost drivers will not make health care coverage more affordable for families and employers,” said Karen Ignagni, the chief executive of America’s Health Insurance Plans, a trade group, in a statement responding to the new rule.
She also warned against “an arbitrary threshold for review” that may not adequately take into account the complicated array of factors that determine premium rates.
While the new rule does not give states or the federal government new authority to reject rates before they go into effect, it forces insurers to explain the reasons behind any double-digit increases, according to federal officials. The rule only applies to policies offered to individuals or small businesses because large employers buying coverage for their workers tend to be more sophisticated purchasers, and some states may not have the authority to review premiums for large groups.
Federal officials emphasized that a key aspect of the new rule is the requirement that insurers publicly show their work on the federal government’s Web site and on their own. While some states have the authority to reject rates before they go into effect, the law relies more on increased scrutiny to pressure insurers to keep rates in check.
How effective do you think making insurers publicly justify large rate increases will be in keeping a lid on double-digit premium increases?
© 2011 The New York Times Company
http://prescriptions.blogs.nytimes.com/2011/05/19/double-digit-insurance-rate-increases-get-more-scrutiny/ [no comments yet]
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