Inside Health Policy, November 20, 2014
The executive director of the Missouri consumer advocacy group that had filed action against HHS for failing to provide information on issuers' proposed rate increases called the department's recent release of premium data too little too late, and said she remains disappointed with the department. HHS did release some of the information but did so in a non-user friendly manner, using spreadsheets instead of forms that are difficult to review and still did not include the needed data.
Advocates are “very disappointed” about the failure to include the detailed information, Joan Bray, executive director of the Consumer Council of Missouri, said in a Wednesday call with reporters. She said that while some data was available, HHS did not release the information in 'Part 3” of the rate justifications in which issuers are supposed to explain the assumptions behind their proposals. Bray said that from what staff “can figure out so far,” after looking through the 135 columns and more than 65,000 rows of data, is that the rate increases in Missouri exceed the national average. She pointed out that a Blue Cross plan in Kansas City increased rates by 13 percent and a Coventry plan for HMOs has gone up by 23 percent.
The fundamental purpose of the the regulation was to enable the public to analyze and to comment on proposed increases, Bray said. Missouri does not have a regulator who is involved so it is critical for public interest groups to be able to see the proposed rates, figure out if they are justified and comment on them.
HHS is boasting about how transparent it is being and how the release enables academics to conduct research on the rates, but the point of the law is not about academic researchers it is about consumers, Bray argued.
Is it extremely important for Missouri, in particular, that HHS to comply with its own regulations since the state does nothing to enforce or even monitor compliance with the ACA due to state law. But HHS has “shirked” its responsibility, Bray said, adding that she is “very offended” that consumers in her view Missouri are treated as second class citizens when it comes to implementation of the law.
Although there may be no power to force plans with large proposed increases to come down, Bray said, HHS can and should hold public hearings in cases where they may be unjustified. In other states, when regulators shined the light on large increases the companies themselves backed off and returned with lower numbers, she pointed out.
Meanwhile, Bray said, open enrollment will go on and people will have to live with the rates. She said the group continues to study and prepare for next year since “we don't want this to happen again."
As far as the case itself, Bray said there is still no court date.
In September, former CMS insurance chief Jay Angoff had filed suit in the U.S. District Court in Eastern Missouri against HHS on behalf of the council. The lawsuit specifically deals with insurance rates in Missouri, which does not require insurers to file documentation with the state or make information public regarding proposed rates. The lawsuit says that, as a result, residents of the state are entirely dependent on HHS for information about insurance rates and insurers' justifications for those increases. The suit says the consumer groups have a statutory right to obtain the information and HHS has no legal basis for failing to disclose those records.
CMS on Friday released the premiums for all states, but the agency did not include any analysis except to note that premiums were stable. Avalere Health offered an initial look of rates for federally facilitated exchange states, which includes Missouri.
According to Avalere's analysis of Missouri plans, the lowest cost Bronze plan increased an average 9 percent, compared to a 3 percent for all FFM states, the lowest cost Silver plan increased 5 percent compared to the 4 percent FFM average, and the second lowest Silver plan increased by 7 percent in the state, compared to the 3 percent average for all FFM states.