We’ve been running a lot of articles this year about state insurance regulators tinkering with health insurers’ 2015 individual rate proposals.
Regulators in states like Connecticut and Maryland are disagreeing with the medical cost trend figures insurers use, or how the insurers account for support from the Patient Protection and Affordable Care Act (PPACA) risk management programs.
On the one hand, for consumers and small employers, watching state insurance regulators cut increase requests is satisfying. Big insurers have been highly profitable in recent years, and they get help with fattening their profit margins from big regulatory moats that shut out would-be competitors.
But, on the other hand, PPACA World has made predicting how health care prices, use of health care and commercial health insurance claims will perform especially this tricky year and next year. Insurers have no good way to know, for example, whether Congress will let the PPACA risk-management programs pay what they’re supposed to pay, in full, on time. Even if Congress leaves the programs and their funding alone, who knows whether insurers, state regulators and the U.S. Department of Health and Human Services (HHS) program managers will calculate the risk program payments the same way?