SAN ANTONIO — Several states have saved consumers millions in health insurance premiums by keeping a firm hand on rate hikes and spotlighting carriers’ proposed prices.
Those hoping for similar results in Texas, however, may be out of luck.
Texans have no opportunity to compare which health insurance companies propose the biggest increases each year before new prices take effect. Nor do customers have access to all the explanations given to state regulators to justify such changes.
“There is no standard in Texas for releasing this information to consumers and to advocates who want to make sure consumers are getting the best deal on their health insurance policies,” said Blake Hutson, a senior associate for healthcare reform at Consumers Union’s Southwest office in Austin. “We’re the worst of the worst when it comes to protecting consumers from unjustified rate increases in health insurance.”
The Affordable Care Act set out to bring more scrutiny and transparency to rate reviews nationwide, requiring that experts review premiums going up 10 percent or more for individual and small group health plans. Since that mandate took effect in 2011, the pace of surging premiums has slowed, according to the Health and Human Services Department.
Regulatory powers and public disclosure still vary widely from state to state, however. For instance, the Texas Insurance Department does not put proposed increases for health plans on its website, though some other states do.
Nor do the Centers for Medicare and Medicaid Services, which leave it up to states whether to disclose such information in a public forum, a federal official said on background.
The state Insurance Department has limited powers when it comes to regulating health plan prices for individuals and small groups, experts say. The agency cannot explicitly approve or disapprove such rates because the state Legislature has not granted it statutory authority to do so.
Nevertheless, the department reviews proposed prices for all individual and family health plans sold in Texas to make sure they are adequate, just, fair and nondiscriminatory.
That involves determining whether prices are “actuarially sound” – evaluating whether a carrier’s assumptions and methodology are based on credible data, said Jan Graeber, chief actuary in the agency’s life health division.
If an insurance company’s explanations fall short, the state might request additional documents or the carrier could adjust its projections. It’s unclear what power, if any, the agency has to force resolution in such cases.
Most of this work happens away from the public eye. Texas consumers usually have no idea whether their health premiums will increase or how much until they are notified by their carrier, experts say.
“I don’t know how a [Texas] consumer right now would get information on what [the] rate increases are until they get a letter from the insurer, saying, ‘Here’s how much your rates are going up,’ ” said Stacey Pogue, senior policy analyst at the Center for Public Policy Priorities in Austin.
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