Insurers, consumers, regulators clash over premiums at state hearings

Document titled "Patient Protection and Affordable Care Act"

Photo credit: Getty/designer491

As states review rate requests for Affordable Care Act exchange plans, the tension among frustrated health insurers, fed-up consumers and skeptical regulators has boiled to the surface at public hearings across the country, according to The New York Times.

Citing mounting financial losses in the individual market, many insurers have requested double-digit premium hikes for 2017.

The Obama administration has argued that insurers’ requests are not indicative of what consumers actually pay, and recently added that medical costs for exchange enrollees has leveled out. But already state insurance officials such as New York and Mississippi have approved large rate hikes for insurers.

In hearings held by state regulators, insurers are trying to make their case for why the premium hikes are necessary, the Times notes.

For example, Highmark’s vice president of actuarial services pointed out during a hearing in Pennsylvania last month that nearly 250 ACA policyholders each incurred more than $100,000 in claims and then canceled their coverage before the end of the year. That behavior, he says, drives up costs for the whole risk pool.

Consumers at the Pennsylvania hearing, though, said premium costs are straining their finances at unsustainable levels, according to the article. Similarly, in Connecticut, an Anthem customer called the insurer’s requested rate hike of 27 percent “just off the charts and unacceptable.”

At another hearing, the Times notes that state Insurance Commissioner Monica Lindeen questioned Blue Cross Blue Shield of Montana’s requested rate increase of 62 percent--and also wondered why parent company Health Care Service Corporation had not cut down on its executive pay.

A Blue Cross official, though, said high medical claims costs are driving the rate hikes, and noted that executive pay is a very small share of total expenses.

- read the Times article
- here’s New York’s announcement
- check out Mississippi’s statement

Suggested Articles

We may not yet have a proven therapy to treat COVID-19 or a vaccine to stop its spread, but we do have a tool at our disposal that can help: Medicaid.

Digital transgender health company Plume is expanding into employee benefits. Here's why.

According to a new report, 79% of facilities scored less than a C in terms of conformance with national cybersecurity standards.