Affordable Care Act grants provide $3,000,000 to help fight health insurance premium hikes in New Mexico

WASHINGTON--(BUSINESS WIRE)--U.S. Department of Health and Human Services (HHS) Secretary Kathleen Sebelius today announced Affordable Care Act grant awards of $3,000,000 to New Mexico that will help fight unreasonable premium increases and protect consumers. Today, HHS also released a new report entitled Rate Review Works detailing how previous rate review grants are fighting premium hikes and helping make the health insurance marketplace more transparent.

“We’re committed to fighting unreasonable premium increases and we know rate review works”

“We’re committed to fighting unreasonable premium increases and we know rate review works,” said Secretary Sebelius. “States continue to have the primary responsibility for reviewing insurance rates and these grants give them more resources to hold insurance companies accountable.”

As of September 1, 2011, the Affordable Care Act requires health insurers seeking to increase their rates by 10 percent or more in the individual and small group market to submit their request to experts to determine whether the rates are unreasonable. The Affordable Care Act also requires insurance companies to publicly justify unreasonable premium rate increases. These provisions will bring greater transparency, accountability, and, in many cases, lower costs for families and small business owners who struggle to afford coverage.

The Affordable Care Act provides States with $250 million in Health Insurance Rate Review Grants, $48 million of which has previously been awarded to 42 States, the District of Columbia and five territories.

As outlined in the new report, these grants and other State rate review efforts are already making a difference in New Mexico. The New Mexico State Legislature passed SB 208 during the 2011 legislative session. This statute will create a more in-depth rate review process with greater consumer transparency. As a result of the passage of SB 208, rate increases are now required to be posted on the Insurance Division’s website for a public notice and comment period, with recommendations made to the Superintendent of Insurance prior to rates taking effect.

The grants awarded today help to create a more level playing field by improving how States review proposed health insurance rates and holding insurance companies accountable for disclosing information about unjustified rate increases.

New Mexico is proposing to use Cycle II grant funds in the following ways:

Expand scope of rate review: New Mexico will give its Consumer and Business Services Task Force the responsibility of reviewing rates and identifying potentially unreasonable increases, triggering further review by a contracted actuary firm.
Improve rate filing requirements: New Mexico will use SB 208 to require insurers to provide additional information with submitted rate filings. New Mexico will also require insurers to make reimbursement for direct services at a level not less than 85% of premiums.
Improve transparency and consumer interfaces: New Mexico will implement the requirements of SB 208, requiring the Superintendent to provide public web access to all health insurance rate filings and a 30 day public comment period for filings. New Mexico will also hold quarterly town hall meetings throughout the State.
Hire new staff: New Mexico will create 2 new positions with the Cycle II grant funding; these positions are in addition to the 4 positions created with Cycle I resources.
Improve IT: New Mexico will use IT Professional Contract Developers to enhance the web application and database data transfer interfaces.

A summary of how each State will use the new resources can be found in the report released today.

“The proposals from the States overwhelmingly demonstrate the need, and desire, for new resources and tools to hold insurance companies accountable,” said Steve Larsen, Director of the Center for Consumer Information and Insurance Oversight. “Thanks to the Affordable Care Act, States will have more of the tools they need to crack down on insurance companies that want to pass unreasonable premium hikes on to hard working families.”

Information about significant State achievements with previous rate review grants can also be found in the report.

Rate review builds on other provisions in the Affordable Care Act to help make health insurance more affordable for individuals, families, and businesses. Other steps the law takes to help make insurance more affordable include:

Insurers are generally required to meet a medical loss ratio standard to spend at least 80 percent of premium dollars on health care and quality-improvement activities as opposed to overhead, advertising, and executive bonuses. Insurers that fail to meet that standard must either reduce premiums or pay rebates to consumers and employers;
Small businesses are eligible for Federal tax credits of up to 35 percent of the cost of coverage for their workers. That amount rises to 50 percent by 2014; and
In 2014, the Affordable Insurance Exchanges will use competition and transparency, including information on excessive or unjustified premium increases, to help make insurance more affordable.

The Affordable Care Act includes a variety of provisions designed to promote accountability, affordability, quality, and accessibility in the health care system for all Americans, and to make the health insurance market more consumer-friendly and transparent. Some of the provisions are already in effect, including prohibitions on pre-existing condition exclusions for children; prohibitions on lifetime dollar limits in all health plans; extended access to insurance for many young adults; and an unprecedented level of transparency about health insurance through www.HealthCare.gov.

For the full Rate Review Works report, please visit: http://www.healthcare.gov/law/resources/reports/rate-review09202011a.pdf

For a fact sheet on the awards announced today, please visit: http://www.healthcare.gov/news/factsheets/2011/09/rate-review09202011a.html

Note: All HHS press releases, fact sheets and other press materials are available at http://www.hhs.gov/news.