By Joseph Burns
As the nation’s health insurers file rate requests with state insurance departments, the news about health insurance premium increases is coming out almost daily now. The deadline for submitting rate requests on the marketplaces is June 27.
Premium rate review is an important story, obviously, because it begins to answer the question of what consumers will pay for insurance next year as Louise Radnofsky reported in The Wall Street Journal.
But it’s also a complex story because what health insurers propose now is not necessarily what consumers will pay next year, and, in fact, insurance rate requests are only part of the story, as Trudy Lieberman reported last week in the Columbia Journalism Review.
For journalists seeking resources on how to cover insurers’ rate requests, Lieberman’s story is a great place to start. She explains that what insurers are proposing now is what they would like to charge for policies to be sold on the exchanges starting in November. But these rates are preliminary because they are subject to state and sometimes federal review and approval, she cautions.
Also, insurance premium rates are only a part of what goes into what health insurance costs individual consumers, she adds, and she explains how so many other factors affect what consumers pay in the seven tips that she provides for journalists seeking to cover this issue with depth and clarity.
Another resource for journalists comes from researchers at the Leonard Davis Institute of Health Economics who published a policy brief this month, Deciphering the Data: Health Insurance Rates and Rate Review. Their efforts were supported by the Robert Wood Johnson Foundation. The brief provides background for understanding the economic factors driving the proposed rates, the effects of rate changes on marketplace enrollees and federal premium credits, and the economic and political dynamics of the rate review and approval process.
Another must-have resource for those covering this topic is a toolkit for the media produced by Families USA, a consumer advocacy group, and from Consumers Union, the policy and advocacy division of Consumer Reports. Don’t be fooled by the title of the first page of the toolkit, “Rate Review FAQ,” because this resource is much more than a list of frequently asked questions.
For one of the first questions, “What is a rate review?” the answer explains that, when states have ineffective review processes, officials from the federal Department of Health and Human Services review the filings. Then a bit later, there’s a link to a page at the federal Centers for Medicare & Medicaid Services (CMS) that explains which states have effective review and which ones do not (requiring HHS reviews the filings).
The toolkit also explains that when an increase is requested (and sometimes when insurers seek a decrease), insurers must send a summary document about the rate request and an actuarial memorandum. If the rate increase request exceeds 10 percent, then the insurer needs to send a summary of its assumptions about the rate request. Unfortunately, these documents are not always available to the public, but a link is provided to a CMS webpage that shows the latest available information.
For journalists seeking health insurance rate filings for a particular state and the procedures each state much follow to make the filings available to the public, the toolkit explains where to get this information. It also outlines how the public can participate in rate review, although the public is not allowed to participate in every state.
In some states, journalists may need to file a public records or a Freedom of Information Act request to get the rate filing information. If you make such a request and it’s rejected, both Consumers Union and Families USA want to know about it.
Still more resources are listed at the end of the toolkit. Two of the best of these are a guide to health insurers’ rate requests and 50 state overview (PDF) that lists the statutes involved, the type of rate review in each state and how the public can participate.
And, finally, for journalists seeking comparison data on what consumers paid in 2014, HHS issued a report (PDF) on Wednesday on the premiums, competition and choice available to consumers on the health insurance marketplace this year.
