Category: Health Care

MO ins rates sky rocket, data questionable

The Affordable Care Act made health insurance accessible for millions of Americans. But rising rates, a lack of transparency in policy changes and little oversight in the process puts the entire system at risk.

Rates in MO are rising by alarming rates and the data behind these rates hikes are questionable.

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Aetna pulls out of MO marketplace, we deserve better

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Gov. Nixon Signs Bill Protecting Consumers

Gov. Jay Nixon today signed into law a bill that will help protect Missouri healthcare consumers. Senate Bill 865 gives authority to the Missouri Department of Insurance to review rates for health plans offered under the federal Affordable Care Act. Currently, the only review of those rates could be done by federal regulators, acting on behalf of the state.

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Effort to Expand Medicaid Not Over

Legislature Can Still Help More Missourians Get Healthy, Stay Healthy

It’s true the Missouri General Assembly failed in the legislative session that ended May 17 to expand the Medicaid program to include more that 260,000 Missourians.  Most of these uninsured people who would become eligible for health care are working but poor.

According to a study in the New England Journal of Medicine, 1,500 Missourians will die each year until the state legislature expands the program.  Others will continue to face untreated illness and financial devastation because they are uninsured.

Consumers must let state legislators know they still have the opportunity to
save lives, alleviate suffering, create jobs and keep hospitals open throughout the state.

Tell the members of the Missouri House and Senate who represent you that you want them to continue working to expand Medicaid until they get it done.

Here’s a quick link to find your MO State Representative and Senator.

Click here to send a message to your senator.

Click here to send a message to your representative.

TAKE ACTION NOW to give all Missourians have access to quality, affordable health care.

Click here to read why economist Paul Krugman says the Affordable Care Act – Obamacare – can succeed.

More Information

We need to expand Medicaid in Missouri. In this tough economy, more Missourians than ever are out of jobs and many are single parents making barely enough to survive, let alone support a family. Under the national health reform law, Missouri has an opportunity to expand Medicaid to provide health insurance to single parents and childless adults who earn up to 133% of the federal poverty level, or about $25,000 for a family of three. Taking advantage of this expansion is both the right thing to do for Missouri Consumers and the smart thing to do for our State.

Expanding Medicaid is the Right Thing to Do:

  • Being able to see a doctor is a right, not a privilege. Working families should have the right to receive basic medical care when they need it, but tens of thousands of working Missourians can’t qualify for basic health care, and 877,000 currently have no health insurance at all. That’s why Consumers Council of Missouri  is working to expand Medicaid coverage to help insure those who need it the most, like families with children who are working hard to make ends meet. Now is not the time for Missouri to start neglecting its working families.
  • Medicaid saves lives and prevent thousands of deaths every year in Missouri. Expanding Medicaid will help allow 255,000 more hardworking Missourians who earn just a fraction of the federal poverty line to purchase insurance. A recent study shows that expanding coverage could even save the lives of as many as 6% of the people who enroll.
  • Missouri currently makes it harder than almost any other state to qualify for Medicaid. Under today’s rules, a single mother of two can’t qualify for basic health care through Medicaid if she makes anything more than $3,504 per year – just 18% of the poverty line. That’s just wrong.
  • More than 877,000 Missourians are uninsured.  Thisdevastates families, weakens our communities and overburdens our hospitals.  Since the general assembly cut health care benefits for low-income families in 2005, there are now over 877,000 uninsured—that’s one in every seven Missourians. Expanding Medicaid saves Missouri money in the long run and would help allow 255,000 more hardworking Missourians who earn just a fraction of the federal poverty line to purchase insurance. A recent study shows that expanding coverage could even save the lives of as many as 6% of these new enrollees.
  • Missouri spends hundreds of millions on tax breaks for big corporations – including insurance companies – that are making record profits. If we’ve got the money to pad corporate bank accounts, we’ve got the money to invest in making sure all of our neighbors have access to health care – especially the low-income working families who need it most.

Expanding Medicaid is the Smart Thing to Do:

  • Expanding Medicaid will save hundreds of millions of dollars for Missouri in the long run.  If we don’t expand Medicaid, Missouri hospitals could lose nearly $400 million in funding this year alone. This would force 40 to 50 percent of our state’s rural hospitals to close. In fact, losing these hospitals—and the thousands of jobs they create—means it would probably cost Missouri taxpayers more NOT to take the Medicaid expansion. Expanding with federal dollars will allow Missouri to focus on important priorities like education and public safety.
  • Expanding Medicaid means thousands of good jobs in Missouri – more than 24,000 in the first year, according to a new study by the University of Missouri.
  • Choosing not to expand Medicaid force 40-50% percent of our state’s rural hospitals to close. If this happens, tens of thousands of Missourians will be left without a local hospital, leaving both the insured and uninsured with fewer options and resulting in further overcrowding of our remaining hospitals.
  • Expanding Medicaid is affordable for Missouri, with the state paying nothing for the first three years. The national health care reform law provides more than $8 billion for Missouri, meaning our state won’t have to pay anything until 2017 and only 10% of the expansion costs after that.

Missourian consumers want action to ensure access to affordable health care.  Today, 877,000 Missourians don’t have insurance, but it doesn’t have to be that way. We can act now to expand Medicaid so more working families and persons with disabilities can qualify. Doing so will create thousands of new jobs, and save the state hundreds of thousands of dollars. Most importantly, it will save lives and make sure our hard-working neighbors are able to see a doctor. It’s the right thing to do, and the smart thing to do for Missouri consumers.

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Instructions for Commenting to HHS on a Specific ACA Health Insurance Plan’s Rate Increase of More Than 10%

If you really want to get in the weeds and comment on a SPECIFIC PLAN with a proposed increase of 10% or more, do the following:

•  Go to

•  Select “Search ACA-Compliant Products.”

•  Select Missouri and click on “Submit Search.”

•  The search will return a list of insurance plans in the state with proposed rate increases of 10% or greater.  Click on a plan to see the details about the rate hike.


•  After clicking on a plan and reading through the company’s reasons for raising the rates on that particular plan you may want to refer to CCM’s reasons for asking that the company’s rate increases be found excessive.

Blue Cross Kansas City Rate Filing HIOS Issue ID #34762 1-1-16

Coventry (St. Louis) Rate Filing HIOS Issue ID #44527 1-1-16

Coventry (Kansas City) Rate Filing HIOS Issue ID #44240 1-1-16

Cox Rate Filing HIOS Issue ID #96384 1-1-16

Humana Rate Filing HIOS Issue ID #30613 1-1-16

United Rate Filing HIOS Issue ID #14162 1-1-16

•  At the bottom of the page you will find a section called “Consumer Comments” that provides the instructions for submitting comments.

•  Click on, which will auto-populate an email with the appropriate subject line.

•  Write your comments, sign your name and address, and send.

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CCM Asks Feds to Hold Hearing, Find Health Insurance Rate Hikes Excessive

St. Louis, MO (July 30, 2015) — Consumers Council of Missouri is calling on the U.S. Department of Health and Human Services to investigate projected rate increases from Coventry Health Insurance and four other Missouri insurers, each of whom has proposed raising rates by more than 10 percent in 2016.

Coventry Health Care, which is owned by Aetna, is one of the major carriers on the federal exchange for Missouri.  It has filed for 2016 rate increases of more than 20 percent.  Four other insurers have proposed 2016 increases exceeding 10 percent, which is the threshold the federal government set for challenges.

Missouri is the only state in the country in which the Department of Insurance has no authority over health insurance rates and in which health insurers do not even file their rates.  As a result, Missouri consumers are dependent on HHS for information regarding health insurance rate increases, and under the requirements of the Affordable Care Act, HHS reviews health insurance rates for Missouri.

HHS made no rate information public regarding rates proposed for 2014 and 2015.  But this year, after CCM filed a Freedom of Information Act lawsuit seeking the Missouri rate filings, HHS has revealed the rates for all states at a new website,

CCM wants YOU to help!

Please comment on the excessive rates

proposed for 2016.

Here’s how:

Look at these documents related to CCM’s comments on unreasonable rates:

•  CCM’s letter to HHS seeking a hearing on 2016 rates filed by Coventry that increase as much as 28.9 percent and deem the rates unreasonable.  We also ask HHS to find unreasonable the rate increases above 10 percent filed by four other carriers.

•  A summary of the reasons rates proposed for Missouri are unreasonable.

•  Background of on the proposed rate increases for Missouri.

Then CLICK HERE to email your comments.

Some pointers:

•  Subject line – Comments on ACA health insurance rates proposed in Missouri for 1-1-2016

•  Ask the Department of Health and Human Services to deem the rates unreasonable because of specific reasons — choose the ones you like best from the summary and background documents available above.

•  Your comments don’t have to be long but they should be substantive.

•  The only rates that can be challenged are those that exceed 10 percent increases.

•  Sign the email with your name and address.

If you want to get into more detail, read the documents below.

More specifically, if you get your health insurance from one of the five insurance companies that has proposed rates in excess of 10 percent, please comment specifically on it.  (If you comment on a specific plan, put the plan description and number in the subject line.)

Click here for Missouri 2016 Rate Overview.

Click on these links to see comments on the following companies’s plans:

Blue Cross Kansas City Rate Filing HIOS Issue ID #34762 1-1-16.

Comments on Kansas City Coventry Rate Filing HIOS Issue ID #44240 1-1-16.

Comments on St. Louis Coventry Rate Filing HIOS Issue ID #44527 1-1-16.

Cox Rate Filing HIOS Issue ID #96384 1-1-16.

Humana Rate Filing HIOS Issue ID #30613 1-1-16.

United Rate Filing HIOS Issue ID #14162 1-1-16.

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Rate Hike Proposal for Health Insurance in Missouri Draws Consumer Group’s Ire

KWMU, July 31, 2015

Large rate increases for health insurance may be in the works for some Missourians this year, but we won’t know the final prices for a few months.

Last month, insurance companies nationwide submitted their bids for rate increases. The Missouri proposals from Coventry Health Care were among the steepest, including a 29 percent hike for individual plans sold on According to rate filings, Coventry’s rate increases could affect 70,000 people.

Because the state of Missouri does not review its own health insurance rates, federal regulators will decide whether the price hike is warranted. In the meantime, members of the Consumers Council of Missouri are sending letters to the U.S. Department of Health and Human Services objecting to the increases, and asking federal officials to hold a hearing.

The Consumer Council’s executive director, Joan Bray, has long advocated for Missouri to implement its own rate review process.

“There’s only five states in the country that don’t have an adequate rate review process. But Missouri’s the only one that has nothing,” Bray said.

After a lawsuit brought by the Consumers Council, HHS began publishing the proposals for rate increases on its website. Only companies proposing an increase of 10 percent or higher are required to file the paperwork.

“I wouldn’t be surprised if the rate increase is higher this year. And that’s because in general health spending is starting to increase again,” said Tim McBride, a Washington University health economist.

Regulators often negotiate the rate proposals down to more reasonable increases, so speculating on the rate bids is likely premature, McBride said. (He discussed it more broadly on his blog). But he added that the market is still seeing inflation of 4 to 6 percent compared to last year.

“Coming out of the recession, the first couple years of the Affordable Care Act, healthcare inflation was about the lowest it’s been. But it’s starting to return a little more to its more traditional increases,” McBride said. “I don’t think it’s out of control yet, but we’re certainly watching it.”

Aetna spokesperson Rohan Hutchings wrote in a statement that Coventry’s proposed double-digit hikes “simply reflect the costs” of doing business:

“For 2016, we expect that medical costs will grow by 8-10% in the individual market. Other factors driving rates include changes in the reinsurance program (approximately 5-6% increase across all markets), risk pool experience, and taxes and fees,” it read.

Meanwhile, health insurers have enjoyed significant boosts in their market share. Since the implementation of the Affordable Care Act,  16.4 million previously uninsured people have enrolled in health insurance, according to the federal government.

Final rate increases will be published in the fall.

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First Ever Rate Review Process Could Lead to Lower Health Insurance Rates

Consumers Council of Missouri, July 2015

Missouri is the only state in the country in which the Department of Insurance has no authority over health insurance rates.  As a result, under the requirements of the Affordable Care Act the federal Department of Health and Human Services reviews the rates for Missouri.

Because the state doesn’t review rates on behalf of consumers, Consumers Council of Missouri teamed up with Missouri Foundation for Health to analyze the rates for 2016 and let HHS know which rates we believe are unreasonable and excessive.  This is the first time health insurance rates will be reviewed in Missouri before they go into effect.

Unlike some state insurance departments, HHS doesn’t have the authority to disapprove rate increases in the states, but it does have the authority to deem them unreasonable.  And if HHS finds an insurer’s rate increase to be unreasonable, both it and the insurance company must post that finding on their websites.

That’s not a lot of help for consumers.  But it’s something.  And in the past, in other states, some insurance companies have reduced their rates after HHS found them to be unreasonable.

Within the next few weeks CCM will be posting on its website its analysis of the rates for the next enrollment period and the comments we send to HHS about unreasonable, excessive rates.  We will encourage consumers and advocates to file their own comments based on our analysis and will give step-by-step instructions on how to construct and file comments.  Comments may be either emailed to or submitted at .

How the Rate Review Process Works

When insurance companies increase their rates they include a Rate Filing Justification, or RFJ, which contains the documentation supporting the increase.  The RFJ consists of three parts.

Part I is a compilation of the data used to determine the increase.  Part II is a summary explanation of the assumptions used to develop the increase and the most significant factors responsible for the increase.  Part III is the actuarial memorandum and exhibits, which contain the assumptions and reasoning supporting the increase and the data contained in Part I.

Under its Rate Review Rule, HHS must make the filings public in time for consumers to comment on proposed increases and for HHS to consider those comments in determining whether the rate is unreasonable.

Anyone wishing to file comments with HHS on rate increases in Missouri can do so  As noted above, more detailed instructions will come after CCM makes its analysis of the rates and comments public.

CCM has produced a guide to rate filing and rate review, Health Insurance Rate Review for Missouri Consumers, which anyone wishing to comment should find helpful.  Click here to see the guide.

Unfortunately, HHS declined to make the data for either 2014 or 2015 public in time for consumers to comment on proposed rate increases.  However, after CCM filed a Freedom of Information Act complaint in federal district court in St. Louis seeking the timely release of the data, HHS agreed to make public the proposed increases for 2016.  It will also make them available in future years by June 1 of the year before the rate hikes take effect.

HHS has therefore now posted data for 2016 rates at a new website,  Some information in the Part III’s has been redacted – blackened out — because insurers claim that information is trade secret.

HHS has also released to CCM, in connection with CCM’s FOIA complaint, the Part III’s supporting 2015 (this year’s) rates.  Because many of those Part III’s are unredacted, they include data that the 2016 Part III’s do not include. That may make them particularly useful to consumers wishing to comment on proposed 2016 rates.  Click on each rate filing to view it.

2015 Aetna Small Group HMO

2015 Aetna Small Group PPO

2015 Anthem Individual

2015 Anthem Small Group 1-1-2015

2015 Anthem Small Group 4-1-2015

2015 Blue Cross and Blue Shield of Kansas City Individual-1

2015 Blue Cross and Blue Shield of Kansas City Individual-2

2015 Celtic Exhibits A&B

2015 Celtic Individual Major Medical

2015 Cigna Individual

2015 Coventry Individual HMO

2015 Coventry Individual PPO

2015 Coventry Individual

2015 Coventry Small Group HMO

2015 Coventry Small Group PPO-1

2015 Coventry Small Group PPO-2

2015 Cox Individual

2015 Cox Small Group

2015 Federated Small Group

2015 Freedom Individual Major Medical

2015 Humana Individual

2015 Humana Small Group

2015 John Alden Small Group Major Medical

2015 Time Individual Major Medical

2015 Time Small Group Major Medical

2015 United Health Care Individual-1

2015 United Health Care Individual-2

2015 United Health Care Small Business-1

2015 United Health Care Small Business-2

To search the Part I’s, Part II’s and redacted Part III’s requested in 2015 for 2016 and in 2014 for 2015, go to > Search ACA-Compliant Products > Choose a State > Missouri > Submit Search

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Effect of Health Insurance Merger Concerns Local Consumer Advocates

St. Louis Post-Dispatch, July 11, 2015

A proposed merger between two health insurance giants is drawing concerns around the country and in Missouri, as some fear the consolidation could leave older adults in the state with fewer choices for health care.

Earlier this month, Aetna Inc. announced it would acquire Humana Inc. for about $37 billion, a combination that would produce the nation’s second-largest health insurer, just behind UnitedHealth Group Inc.

Spurred on by the new health care environment generated by the Affordable Care Act, the nation’s big health insurers are looking to bulk up, hoping to use their leverage to negotiate lower prices from providers and drug companies.

But the Aetna deal, which would produce a company with more than 33 million customers, is getting the attention of regulators and consumer groups because in some markets, the two companies already are major players. A combination could leave consumers with too few choices, critics say. The deal requires approval from the U.S. Department of Justice, as well as state insurance regulators.

At least three state attorneys general — in Florida, Mississippi and Massachusetts — said they would look at the proposed acquisition. Local politicians and medical industry groups such as the American Medical Association have also voiced concerns about the biggest deal ever in the U.S. health insurance industry.

Missouri is one of the markets where the combination is raising concerns. Both Aetna and Humana have a significant presence when it comes to Medicare Advantage, a government-sponsored program for older adults where a private company manages benefits.

Together, they have 51 percent of the Medicare Advantage market in Missouri, according to data from Kaiser Family Foundation.

Should they combine, most older Missourians would have only two choices when selecting a health care plan. UnitedHealth is the only other major player currently operating in the state’s Medicare Advantage market.

“It’s really terrible from a consumer’s point of view,” said Dr. Ed Weisbart, a family physician and vice president of the Consumers Council of Missouri. “We could end up with one company telling us which hospitals we can go to and which doctors we can go to.”

Aetna and Humana have downplayed the antitrust concerns, arguing their merger would benefit consumers through streamlined care coordination. Spokesman for the two companies referred comment to previous statements made by their executives.

In an interview with CNBC the chief executives for Aetna and Humana said they did not think the issue would prevent their deal from being approved.

“Given the legal advice, we believe this is a very manageable transaction,” said Aetna CEO Mark Bertolini. “We believe it transforms health care.”

Humana CEO Bruce Broussard added that there was little chance of consumer harm in the deal, pointing to regulations in the Affordable Care Act that require insurers to spend the vast majority of money from premiums on medical bills.

In Missouri, the two companies have little overlap in the state’s insurance market for individual consumers and for employer-sponsored coverage. But the Medicare Advantage market is one of the fastest-growing, and will become more consequential as baby boomers age into the program.

Under Medicare Advantage, a private company manages hospital care and doctor’s visits for beneficiaries. They also can include prescription drug coverage. The plans must cover all of the benefits of traditional Medicare, but can go above and beyond. As a result, they can charge higher premiums to recipients, as well as set provider networks and determine which prescription drugs to cover.

Weisbart said less competition could allow companies, without recourse, to narrow consumer options to save money.

“Their interests are in line with making decisions that optimize profit and are not aligned with optimizing public health,” he said.

Tim McBride, a health economist at Washington University, said he started to worry as the number of players in a market dwindled close to one.

“In general, the more market power firms have the higher the prices are for products,” he said.

But McBride added that consumers might be protected because Medicare Advantage is an optional program. If they find prices too high, or choices too narrow, they can always opt for traditional Medicare coverage.

Nationally, Medicare Advantage has about 17 million enrollees, which is about one-third of the program’s total population. It has more than tripled in size during the last decade and is expected to grow even more. Missouri has roughly 318,000 residents in Medicare Advantage plans, according to the most recent federal data.

It’s also been a major, and growing, source of revenue for companies. An increased Medicare Advantage presence was cited by Clayton-based Centene Corp. in its recent purchase of California-based Health Net. And the 4.4 million Medicare members in the combined Aetna-Humana company would make up nearly half of the revenue of the new firm.

When asked about the proposed merger between Aetna and Humana, the state insurance department declined comment other than to refer to several statutes that dictate what the department should consider before signing off on a deal.

Approval of the merger could become more complicated on both the state and federal level if other health insurers start to consolidate. Anthem, currently the nation’s second-largest insurer, is making a bid for Cigna, the fifth-largest. And UnitedHealth, the largest, could make a bid for Aetna or some of the other companies. Should multiple mergers take place, regulators would need to weigh the combined effects on the market.

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CCM’s Cause: Fair Health Insurance Rates

Recent media reports take note of Consumers Council of Missouri’s work on behalf of consumers buying health insurance under the Affordable Care Act.  CCM is spearheading the effort to review proposed rates before they go into effect.

Health Insurance Costs to Rise, But How Much Depends on State

KBIA, July 8, 2015

The cost of health insurance premiums – the amount you pay each month for your plan –  will likely go up in 2016. If state governments approve insurers’ proposed hikes, the average cost for the most common health plans on the federal and state health insurance marketplaces will increase by 14 percent, according to an analysis of proposed rates by HealthPocket, an insurance research and comparison site.

The Affordable Care Act may be best known for requiring all Americans to get health insurance and for providing tax credits to keep costs down for low and middle income Americans. A less well-known component of the law requires insurers to justify increases of 10 percent or more for plans on the individual health insurance marketplace. At the beginning of June, the Department of Health and Human Services posted those proposed rates at The final approved rates must be posted before the 2016 open enrollment period begins on November 15.

These upcoming increases will be revealing, says Kev Coleman, head of research and data at HealthPocket, because it’s the first time since the passage of the healthcare law that insurers will have a full year of claims to back up their pricing. The amount that insurers pay out in claims each year is the biggest factor behind the cost of health plans.

“When the first rates were established in 2014, they didn’t know quite who was going to enroll, how much health care was going to be used, and how expensive it was going to be to deliver that health care,” explains Coleman.

Final rate increases will likely vary from state to state.  In most states, a department of insurance collects the next year’s rate proposal, and shares it publicaly. Each state has the power to negotiate rates with companies. If a state and an insurer cannot come to an agreement, the state government can prevent that company from operating there.

In states that allow public comment, citizens can play a strong role in the rate review process, says Ed Weisbart, vice president of the advocacy group Consumers Council of Missouri. “When consumers can review the rate proposals and actually make informed, intelligent commentary questioning the validity of some of the assumptions that are in the proposed increases, that can have a dramatic impact on the ultimate rates,” he says. 

In five states, there’s not an effective rate review program in place, and the process of posting and reviewing rates is left to the federal Department of Health and Human Services (HHS). However, that agency does not have the power to negotiate rates; only the states can do that. Consumers in states without review programs, like Missouri, are then left in a vulnerable position, says Weisbart. 

States that have a review process allowing for a public comment period may do a better job of keeping rates down. Officials in New York, which has such a process, say consumer input plays a role in what is eventually allowed. Last year the average rate increase request in New York was 13.9 percent, but the final rates approved by the state averaged 5.7 percent.  “We have a pretty protective regime in place to protect consumers,” notes Matt Anderson, spokesperson for the New York Department of Financial Services.

This year, insurers in New York have requested an average 13.5 percent increase in their premiums, while in Missouri the average request is 19 percent. Coleman says there’s no simple basis for comparison for the costs of coverage from two states as dissimilar as New York and Missouri. Several factors, including how much competition there is between insurers and the relative health of the citizens go into the cost of monthly health insurance premiums.

Weisbart encourages consumers to be informed and advocate for themselves by reviewing the data on the HHS website and sending comments to both the federal agency and their congressional representatives. He says his organization is reviewing the rate requests for Missouri and will publish their findings publicly, “hopefully long before [the rates] become permanent.”

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