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CPBJ Extra Blog

Keeping an eye on rate increases

By , - Last modified: November 1, 2012 at 9:10 AM

Has the Patient Protection and Affordable Care Act's health insurance rate review requirement, which subjects proposed increases of 10 percent or more to additional scrutiny, resulted in smaller increases?

Heather Stauffer

A new report by the Kaiser Family Foundation said other factors must be considered — but, yes, it probably has. The requirement has been in place since September 2011. Here's what the report found.

• In 2011, rate increase applications per month across the group of states studied (including Pennsylvania) averaged 53 except in August, just before the requirement went into effect, when they averaged 137.

• The average size of increase requested (6.8 percent overall, 8.1 percent in Pennsylvania) and implemented (5.4 percent overall, 7.7 percent in Pennsylvania) stayed fairly steady throughout the year, but the share of requests above 10 percent "declined markedly": 1 in 3 from January through August, fewer than 1 in 5 from September through December.

• Of the requests to raise rates by 10 percent or more, 34 percent submitted between January and August resulted in a lower rate than the insurer initially requested, compared to 43 percent of similar filings between September and December.

That was for states found to have an effective review process. For states that didn't, or situations not covered by those reviews, Health and Human Services reviewed them. Although HHS cannot disallow increases, it does publicly post its conclusions.

• Of 48 HHS reviews the report considered, 37 applications were deemed unreasonable, nine were reasonable (well, OK, the wording was "not unreasonable") and two were withdrawn prior to review.

• Most unreasonable findings were on the basis of projected failure to meet the medical loss ratio requirement, to which the insurers responded that if they actually exceeded the MLR, they would issue rebates.

To see a list of Pennsylvania insurers that have requested rate increases of 10 percent or more, go here, select Pennsylvania from the "Find Rate Increase Information for Your State" box, and hit search.

Heather Stauffer covers Lancaster County, nonprofits and health care. You can reach her at 717-285-4237, 717-236-4300, ext. 289, or Follow her on Twitter, @StaufferCPBJ.

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