Reporters largely missed the point of a Commonwealth Fund study released this week, that looked at consumer savings under Obamacare’s 80-20 rule, the rule making insurance companies spend at least 80% of your premiums on health care, not overhead.

The authors started with a fact we already knew — that health insurance companies had to pay $1.1 billion in rebates for missing the MLR requirement in 2011 — and that big shiny number distracted the news media. But the authors zeroed in on a much more important fact. Insurance companies successfully reduced administrative costs by $1.184 billion in 2011, but they used those savings to increase profits instead of passing them on to consumers.

Clearly the 80-20 rule isn’t working to contain profits and hold down premiums, especially in states that don’t have tough regulation of insurance premiums.

California Insurance Commissioner Dave Jones launched an audit this week of the state’s largest health insurers to determine if consumers paid too much when insurers were actually saving money and boosting profits. The Commonwealth study found that in California, insurance companies increased profits for individual plans by $88 per member or about $90 million, even though administrative costs went down and every major insurance company imposed rate increases.

These results are more evidence that states need the ability to say no to rate manipulation. Otherwise, insurance companies will keep premiums artificially high to make sure profit numbers stay high too. As we warned HHS Secretary Sebelius more than two years ago:

“In the same way that a Hollywood agent who gets a 20 percent cut of an actor’s salary has an incentive to seek the highest salary, insurers will have incentive to increase health care costs and raise premiums so that their 15 percent or 20 percent cut is a larger dollar amount.”

As Jones said when announcing the audit:

“I have long pushed for the authority to reject excessive health insurance rate increases and this study provides further evidence of why this change in the law is long overdue in California. Health insurers and HMOs continue to impose double-digit premium increases each year and are making larger profits when selling to individuals and families even during these tough economic times.”

Californians will finally have the chance to stop them, by voting at the next ballot on an initiative measure to require health insurance companies to publicly justify rate increases and get approval before they take effect. Learn more at justifyrates.org
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Posted by Carmen Balber, Washington DC Director for Consumer Watchdog and Consumer Watchdog Campaign

Decision Upholds Key Protections Requiring Insurance Companies To Sell and Price Insurance Regardless of Health Status

Today’s decision by the United States Supreme Court to uphold the Affordable Care Act and its mandate that individuals purchase health insurance makes rate regulation the next essential phase of health reform, said Consumer Watchdog today.

Consumer Watchdog praised the court for requiring health insurance companies to sell to people regardless of pre-existing conditions, eliminating medical underwriting, and barring practices like rescission that made health insurance disappear when patients needed it most. These reforms will expand Americans’ access to health insurance and help policyholders get the coverage they are promised, said Consumer Watchdog.

“Upholding the individual mandate makes rate regulation the next essential phase of health reform and we hope the President will join in helping us to keep premiums low now that people are going to be taxed for not having health insurance,” said Jamie Court, president of Consumer Watchdog. “We must ensure health insurance premiums are affordable if Americans are going to have to buy it. The future of health care reform depends on regulating premiums and making health insurance more transparent and accountable.”

Consumer Watchdog’s campaign affiliate, Consumer Watchdog Campaign, is sponsoring a ballot initiative to force health insurance companies to justify rate increases and get approval before they take effect. The ballot initiative is awaiting certification for the ballot. More on the ballot measure at: http://www.JustifyRates.org.

A Consumer Watchdog report finds that strong rate regulation is necessary to hold down costs and keep insurance affordable under health reform. The report examined Massachusetts where rate regulation has begun to successfully hold down premiums after the state’s individual mandate, which was the model for federal reform, failed to control costs.

Download the report “Health Reform and Insurance Regulation: Can’t Have One Without The Other”

After Blue Shield shocked the nation with 59% premium hikes in California last week, the company just refused a request from the elected insurance commissioner to stop the increases for 60 days. 

Blue Shield is making the case for tough premium regulation, because is has proven that it has the power to raise rates as much as it wants at will and refuse even a modest request from the elected insurance commissioner.

After spending the day walking the halls at the state Capitol in Sacramento yesterday, I can tell you Blue Shield made a big mistake when it decided to price gouge its customers. The state legislature is ready for a fight to give the insurance commissioner power to approve or to deny health insurance premium increases before they take effect. (You can help give them the push they need by sending an email to your state representatives today.) If that fight fails, Consumer Watchdog will help the voters decide through a ballot measure whether government should have the power to regulate and roll back excessive premiums.

Blue Shield made an offer in an errant press release it later recalled which no regulator or policyholder can accept. The company said it would let an independent actuary decide rate justification, and decided to live by the policy when news broke.  The problem is that in the absence of legislated standards for what is an excessive premium, an independent actuary has no basis for review of the premium's reasonableness other than whether there is an error in addition, multiplication or subtraction.

Questions abound about how Blue Shield can justify its 59% premium hike other than by the means it seeks — an actuary to say all the math is good. The standard Californians deserve is that the rates are not excessive or discriminatory. That's the standard for the prior approval of auto and homeowner insurance rates in California that are rejected or accepted by our elected insurance commissioner. The standard saved drivers $62 billion on their auto insurance according to the Consumer Federation of America.

Blue Shield is more opaque than any health insurance company in California because of its unique tax status. We don't know how much the CEO makes, nor can we adequately see the company's the books since it is neither publicly traded nor a tax exempt charity that must make its tax returns public.  Suspicion is Blue Shield cooked its books, and hid big sums of money, to justify the 59% increase.

Only subpoenas and special investigative hearings will determine the truth in the absence of new authority given to the elected insurance commissioner Dave Jones. Legislation by Assembly Member Feuer will give the commissioner that power and it is precisely what Blue Shield's second PR problem in two weeks sought to derail.  Once again, Blue Shield has made the case for exactly the tough regulation it seeks to stop.

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Posted by Jamie Court, author of The Progressive’s Guide to Raising Hell and President of Consumer Watchdog, a nonpartisan, nonprofit organization dedicated to providing an effective voice for taxpayers and consumers in an era when special interests dominate public discourse, government and politics. Visit us on Facebook and Twitter.