States Take Steps to Improve Oversight and Consumer Engagement In the past few months, several states have taken dramatic steps to strengthen their rate review authority, protect consumers, and call out insurers on excessive rate increases. For example, earlier this year, California health insurers announced planned rate increases that would have driven premium costs up as much as 87 percent for some individuals. But in the face of increasing insurer profits, Insurance Commissioner Dave Jones elicited promises from California’s major health insurers that they would decrease and delay implementing proposed rate increases until the state had a chance to evaluate the accuracy of the insurers’ filing. This week, Consumer Watchdog released a report indicating state reviews of insurer rate increases found erroneous math and unsupported actuarial assumptions in rate filings submitted by health insurers. California legislators are moving legislation to give the insurance commissioner explicit authority to disapprove of or reduce proposed premium increases through the state Assembly.

And in New Mexico, the state’s Republican Governor recently signed into law a bill that enhances the state’s rate review authority. The new law includes strong provisions encouraging public participation by establishing a thirty day public comment period on proposed rate increases and requiring insurers to notify policyholders of any possible increase in their premium rate before the increase can be implemented. The statute further gives policyholders the right to request a public hearing on rate increases that the Insurance Superintendent has approved.

Affordable Care Act Mandates Rate Review The Affordable Care Act requires an annual review of unreasonable health insurance premium increases. Federal regulations, soon to be finalized, outline the process through which the U.S. Department of Health and Human Services (HHS), together with state regulators, will review and evaluate health insurance premium rate increases.

While several states currently have review processes requiring a comprehensive evaluation of proposed rate increases before insurers may charge consumers and businesses more for their premiums, other states are using the new federal rate review requirement to expand consumer protections. In February, HHS announced $200 million worth of federal grant money available to states to help them strengthen their rate review processes and states will finalize their application for this money this summer.

Together with their Insurance Departments, and independently, state consumer health advocates are making tremendous progress toward protecting consumers from unreasonably high insurance premium increase. At the end of this blog post you will find new resources Community Catalyst has developed to assist states in advocating for stronger rate review laws.

State Advocates are Helping to Improve Rate Review Processes State consumer health advocates all over the country are taking the lead to guide their states toward revising and implementing stronger rate review laws. For example, in Pennsylvania, the PA Health Access Network is developing an online petition that they intend to use to encourage their insurance commissioner to hold public hearings on proposed rate increases, giving consumers and policyholders the opportunity to provide input on rate increases.

Advocates with Illinois’ Campaign for Better Health Care are supporting legislation that would give their insurance commissioner authority to disapprove or reduce proposed premium rate increases. Recent data released by the Illinois Department of Insurance shows that while insurance premium rates have increased 181 percent since 2005 for individuals and families in Illinois, the top five insurers brought in more than $28 billion in profits in 2010 alone.

And in Ohio, advocates at UHCAN Ohio are in the research phase of their campaign to improve the state’s rate review process, enhance transparency and consumer involvement as a means to protect individuals, families, and small businesses from rising health insurance costs. These advocates are in communication with officials at the Ohio Department of Insurance to better understand the current rate review process and gather data about increasing premium rates.

While we provide three examples here of state advocates working to strengthen their states’ rate review laws and two states where reform is on the horizon, many other states are progressing toward stronger, consumer protective rate review processes or currently have robust laws on the books.

Tools for States to Engage in Rate Review Reform Because most states will continue to oversee health insurance premium rate increases in their markets, Community Catalyst has designed a toolkit to assist state advocates in evaluating their state’s current rate review process and to develop advocacy resources supporting stronger rate review laws. Use the general fact sheet to explain rate review to policymakers and community organizers. The state-specific template is a guide to asking the right questions and gathering the right information and data to demonstrate the critical need for enhanced rate review authority in your state.

— Sarah Blumenthal,  blog contributor