Cracking Down on Insurance Companies, Protecting Consumers

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By Kathleen Sebelius, Secretary of Health and Human Services
http://www.healthcare.gov/blog/2012/01/ratereview01122012.html

The health care law gives us new tools to protect consumers who are looking for health insurance.  One of those tools is “rate review”.  For the first time ever, in every State, insurance companies are required to publicly justify their actions if they want to raise rates by 10 percent or more. These increases are then reviewed by independent experts to decide whether they are reasonable – providing unprecedented transparency and easy-to-understand information about why insurers want to raise your rates. Thanks to health reform, if your insurance company wants to hit your wallet with a major increase, they have to tell you why. And if you don’t like what they have to say, you can take your business elsewhere.

Today, we’re using this tool to protect consumers and crack down on unreasonably high rate increases. We’re announcing that Trustmark Life Insurance Company has unreasonably raised health insurance premiums in: Alabama, Arizona, Pennsylvania, Virginia, and Wyoming – which would affect nearly 10,000 residents across these five States.

In each instance, Trustmark raised rates by 13 percent or more over the last year.   For small businesses in Alabama and Arizona, when combined with other rate hikes made over the last 12 months, rates have increased by 27.2 percent and 18.1 percent, respectively. You can view more information about these rates here.

These increases are unreasonable and it’s time for Trustmark to immediately rescind the rates, issue refunds to consumers or publicly explain their refusal to do so.

The steps we’re taking today are just one way the Affordable Care Act is helping control health care costs and protect consumers. In addition to the review of rate increases, many States have the authority to reject unreasonable premium increases.  Since the passage of health reform, the number of States with this authority increased from 30 to 37, with several States extending existing “prior approval authority” to new markets.  And states are using this authority to save money for families and small businesses:

  • In New Mexico, the state insurance division denied a request from Presbyterian Healthcare for a 9.7 percent rate hike, lowering it to 4.7 percent;
  • In Connecticut, the state stopped Anthem Blue Cross Blue Shield, the state’s largest insurer, from hiking rates by a proposed 12.9 percent, instead limiting it to a 3.9 percent increase;
  • In Oregon, the state denied a proposed 22.1 percent rate hike by Regence, limiting it to 12.8 percent.
  • In New York, the state denied rate increases from Emblem, Oxford, and Aetna that averaged 12.7 percent, instead holding them to an 8.2 percent increase.
  • In Rhode Island, the state denied rate hikes from United Healthcare of New England ranging from 18 to 20.1 percent, instead seeing them cut to 9.6 to 10.6 percent.

The Affordable Care Act also includes new rules that help give you a better value for your health care dollar. The law’s 80-20 Rule requires insurers to spend at least 80 cents of each premium dollar on actual health care services and activities that improve health care quality, rather than administrative costs and CEO bonuses.  If insurers don’t abide by this rule, they will be required to give you a rebate.

By Trustmark’s own admission, they didn’t plan to abide by the 80-20 rule, leaving small businesses with an unreasonably high premium.  For this reason, we have found Trustmark’s rate increases to be unreasonable.

The Affordable Care Act is making our health insurance marketplace more transparent and helping to fight high premium increases and we will continue to do all we can to shine a light on insurance companies who stick consumers with an unreasonable bill.

For more information about this rate review and to find rate increase information in your state, visit: http://companyprofiles.healthcare.gov/

For general information about rate review, visit: http://www.healthcare.gov/law/features/costs/rate-review/