Georgia seeks delay on high health care premium approvals



Georgia’s insurance commissioner is asking for a 30-day delay on approving premiums for insurance plans offered under the Affordable Care Act in Georgia, many of which carry substantial increases.

Ralph Hudgens acknowledged that the most extreme examples are in comparison to a plan with a very high deductible and limited benefits that cannot be offered through the state Health Insur­ance Marketplace. In addition, there will be subsidies for about 800,000 Georgians to make those policies more affordable, a Georgia advocate said.

Hudgens wrote Health and Human Services Secre­tary Kathleen Sebelius asking for a delay on approving premiums submitted by seven insurance companies for providing individual policies through the exchange. The deadline to approve those rates is Wednesday.

Hudgens said he had outside actuaries look at the rate increases and that in all but one case the actuaries “said these rates are appropriate, they are not excessive; that’s what (the companies) need to remain solvent.”

One premium request was judged to be about 11 percent too much; Hudgens said he would just roll the premium back by that amount.

The most extreme increase was 198 percent in one plan, but Hudgens acknowledged that was in comparison with a plan no longer available that had a $5,000 deductible and covered only some services.

For younger consumers, the increase was about 100 percent over previous policies; for middle-age consumers it averaged 50 percent to 60 percent; and for older consumers the increase was about 20 percent to 40 percent, Hudgens said.

Much of that is because of what must be in plans sold in the exchange, including a list of essential benefits, no denial of pre-existing conditions and guaranteed coverage. Also, policies for older consumers cannot be more than three times more expensive than what is offered younger consumers, Hudgens said.

“All of these are mandates that come out of the Affordable Care Act,” he said. “So to comply with those, that’s what the actuaries have come back and said these policies, they’re correctly priced.”

In other states, those kinds of increases have not occurred or the state has worked with resources available through the Affordable Care Act to get better rates, said Cindy Zeldin, the executive director for Georgians for a Health Future.

Last week, Maryland went back to insurance companies and got them to lower premiums, Zeldin said.

The federal government might not agree with Geor­gia’s experts, Hudgens said.

“Once I make that determination (to approve the rates), then (Sebelius) can come along behind me and say, ‘Mmm, no, I’m not going to agree with you. I’m going to cut them 25 percent or I am going to cut them X percent,’ whatever she wants to cut them,” he said. “That is not going to bode real well for me.

“That says that I’m not protecting the consumers of the state of Georgia. So I am asking her in this 30 days, would you with your experts determine whether or not these rates are excessive?”

HHS spokeswoman Joanne Peters said in an e-mail that the department is “working closely with states to help them meet all deadlines and ensure that the marketplaces are ready for consumers to begin shopping on Oct. 1” when open enrollment begins.

“We have received Geor­gia’s request and are reviewing it,” she added.

If HHS does not grant the extension, Hudgens said, he will have to approve the rates.

Even with those premium prices, about 800,000 people in Georgia will qualify for tax credits that will make insurance more affordable for them, Zeldin said.

“It’s really important for consumers to know they are going to be available to them and not to be deterred from seeking out information about plans,” she said.

Geor­gia’s office also held a hearing on proposed Georgia regulations to license navigators, those trained to help educate consumers on choices in the exchanges. In addition to the 25 hours of federally required training, Geor­gia asks for an additional 10 hours of training on the Medi­caid and PeachCare programs, Hudgens said.


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