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Pennsylvania To Put Health Surveys Under Microscope

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Pennsylvania regulators will be investigating rate increases and use of health profiling tools at the state’s nine largest health insurers.

U.S. Health and Human Services Secretary Kathleen Sebelius and members of Congress have been criticizing health insurers in California and other states for imposing rate increases over 20% in recent months.

Pennsylvania Gov. Edward Rendell, D, says his state also is seeing “truly exorbitant rate” increases, with some small group increases exceeding 50%.

“This is about companies trying to get the highest possible rates before the federal reforms take effect,” Rendell says in a statement.

Pennsylvania insurance regulators have little authority to control small group rates, and health insurers in the state can raise a group’s rates if a member of the group has a serious health condition, officials say.

The new federal Affordable Care Act, the legislative package that includes the Patient Protection and Affordable Care Act, will prohibit insurer discrimination against sick people, Rendell says.

Pennsylvania plans to apply for a $1 million federal grant to strengthen oversight over insurance premiums, Rendell says.

In related news, the Pennsylvania Insurance Department says insurers in the state seem to be expanding use of individualized medical questionnaires and prescription drug use analysis in the small group insurance market, according to Pennsylvania Insurance Commissioner Joel Ario.

The two biggest health insurers in Pennsylvania, Highmark Inc., Pittsburgh, and Independence Blue Cross, Philadelphia, do not use the profiling tools, but the 7 other largest insurers do, Ario says.

Several insurers and insurance groups who were asked to comment on the Pennsylvania announcement were unavailable to comment or not yet familiar enough with the announcement to discuss it.

Highmark, the parent of several Pennsylvania Blues plans, “recognizes that the premium increases represent a burden for many small companies and organizations,” says Michael Weinstein, a Highmark spokesman. “For more than 7 years, Highmark has urged the Pennsylvania General Assembly to pass small group insurance reform legislation that would establish the same rating regulations for all insurers in the small employer insurance market and eliminate the use of medical questionnaires to set rates.”

Independence Blue put out a statement noting that it does not yet know much about the investigation. “However, we are pleased that the governor’s announcement pointed out that we do not engage in medical underwriting in the small group market,” the company says.


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