Recursos para ayudar a los estados contra el aumento de las primas del seguro médico
Before the Affordable Care Act, insurance companies in many states increased health insurance premiums with little oversight, transparency, or public accountability. Only 26 states and the District of Columbia had the legal authority to reject a proposed increase that was excessive, lacked justification or otherwise exceeded state standards, and many states that had the authority to do this lacked resources to exercise it meaningfully. This lack of authority and resources for states created an uneven playing field for consumers and contributed to unjustified premium increases in some states.
Examples of insurance premium hikes reviewed by states during this time, based on public reports, include:
- In New Mexico, Blue Cross Blue Shield proposed to raise health insurance premiums by an average of 21% on some of its members in the individual market for 2010.
- In Michigan, in 2009, Blue Cross/Blue Shield of Michigan requested approval for premium increases of 56% for plans sold on the individual market.
- In Oregon, Regency Blue Cross Blue Shield requested a 20% premium increase for 2009.
- In Rhode Island, UnitedHealth, Tufts, and Blue Cross requested 13 to 16% rate increases for 2009.
- In Washington, in 2007, health insurance premiums for some individual health plans increased by up to 40% until the state imposed stiffer premium regulation in 2008.
The Affordable Care Act provides states with $250 million in Health Insurance Premium Review Grants over five years to help create a more level playing field by improving how states review proposed health insurance premium increases and holding insurance companies accountable for unjustified premium increases.
On August 16, 2010 the Department of Health and Human Services announced the award of $46 million to states in the first round of these grants, known as Cycle I. Rate review grants were subsequently made available to territories on September 1, 2010 and were awarded on March 29, 2011. On September 20, 2011, HHS announced a second round of awards -- referred to as Cycle II -- totaling $109 million to be used by states for up to three years. On September 21, 2012, HHS awarded Phase II of Cycle II totaling $8 million to states and territories to be used for two years. These grant funds are helping states improve their reviews of proposed health insurance premium increases, take action against insurers seeking unreasonable rate hikes, and ensure consumers receive value for their premium dollars.
Qué significa esto para usted
All across America, some consumers and employers were confronted with large, double-digit health insurance premium hikes. The proposals from the states and territories overwhelmingly demonstrated the need, and desire, for new resources and tools to hold insurance companies accountable.
Previously, the authority to prevent unreasonable premium increases varied considerably across states and across markets. Before the Affordable Care Act, only 26 states and the District of Columbia had the authority to reject a proposed increase that was excessive, lacked justification or otherwise exceeded state standards. Experience showed that, in these states, proposed health insurance premium increases could be moderated. Por ejemplo:
- On August 6, 2010, Blue Cross Blue Shield of Massachusetts agreed to a significant reduction of proposed increases – less than 13% instead of the nearly 23% they initially requested.
- In 2010, Oregon disapproved health insurance premium requests of 10%, 18% and 20% in the individual market.
- In February of 2010, Anthem Blue Cross of California requested a 39% increase in health insurance premiums in the individual market. Luego de que la secretaria Sebelius y funcionarios estatales pidieran una justificación pública de estos aumentos, Anthem Blue Cross retrasó el aumento de sus tarifas por dos meses. Después de un examen adicional, una auditoría independiente encontró errores en los cálculos de Anthem que originó la cancelación de su solicitud, lo que demostró además que es necesario realizar un examen más minucioso de las primas del seguro médico.
These grants are providing states with the resources they need to perform this type of review.
Ayudar a los estados que los aseguradores asuman su responsabilidad
States are using this funding in a variety of ways.
- Pursue Additional Authorities: States are seeking authority to create a more robust program to review rates or to require advanced approval of proposed health insurance premium increases to ensure that they are justified.
- Ampliar el alcance de la revisión de las primas del seguro médico: Many states are expanding the scope of their current health insurance review, for example by reviewing and requiring pre-approval of rate increases for additional health insurance products in their state.
- Mejorar el proceso de revisión de las primas del seguro médico: All grantees are requiring insurance companies to report more extensive information through a new, standardized process to better evaluate proposed premium increases and increase transparency across the marketplace.
- Divulgar públicamente más información: States are using funds to increase the transparency of the health insurance premium review process and provide easy to understand, consumer friendly information to the public about changes to their premiums.
- Desarrollar y actualizar la tecnología: State grantees are developing and upgrading existing technology to streamline data sharing and put information in the hands of consumers more quickly.
A map summarizing how each state will use the new resources can be found at http://www.healthcare.gov/law/resources/grants/index.html.
Otras políticas de la Ley del Cuidado de Salud a Bajo Precio que permiten que la asistencia médica sea asequible
These grants build on the Obama Administration’s work with states to implement the Affordable Care Act. Beginning September 1, 2011, the health care law implemented federal rate review standards. These rules ensure that, in every state and territory, insurance companies are required to publicly submit for review and justify their actions if they want to raise rates by 10% or more. Otras disposiciones legislativas destinadas a mejorar la asequibilidad incluyen:
- Insurers are generally required to spend at least 80% of premium dollars on medical care services and quality-improvement activities and limit their spending on overhead, marketing, CEO salaries, and profits.
- In 2014, the Affordable Care Act empowers states to exclude health plans that show a pattern of excessive or unjustified premium increases from the new health insurance Exchanges.
La Ley del Cuidado de Salud a Bajo Precio incluye una gran variedad de disposiciones destinadas a promover un sistema de cuidados de salud de alta calidad y valor para todos los estadounidenses, y a hacer que el mercado de seguro médico sea más beneficioso para los consumidores y transparente.
Publicado el: 16 de agosto de 2010
Última actualización: 1 de octubre de 2010