Health Insurers’ Rate Increases Being More Scrutinized

A group of states with a combined population of just under 50 percent of the U.S. population is trying to circumvent the process by which insurers publish premium rates before those published rates reach the marketplace. Ordinarily, individual states would have to receive the approval from their regulatory bodies (insurance commissioners) to review and approve or disapprove rates before they are published in the market. Doctor Pundit readers may recall that one of California’s major insurers, Wellpoint, lowered rate increases after intense media and political pressure forced smaller increases by approx. 7 percentage points.

That state’s IC action has led its lawmakers to consider applying the same statutes to group and individual plans on the open markets. The entire Wellpoint saga couldn’t have come at a worse time for the insurer. With an Arnold Schwarzenegger-approved massive budgetary deficit amid a national slumping economy and presidential push for reform going in high gear, the provider became the poster child for insurance reform in the overall drive of the Obama admin’s push for healthcare reform — garnering critical public support in advance of the law — in the process. States and the HHS would have the power to scrutinize insurance providers considering increases of 10 percent or more.

Insurers are quick to criticize this latest managed care regulatory act, accusing governments of focusing on perceptions of profits by insurers instead of what truly drives healthcare costs — healthcare delivery and utilization. Looks like they may have to get used to things playing out this way, as other states — such as Connecticut, Maine, Massachusetts and New Mexico — are either rejecting rates or adopting legislation to give state insurance commissioners additional rate review authority. | LINK