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Health Care Reform:

Health Insurance & Affordable Care Act

WebMD News from Kaiser Health News

Good News On California ACA Rates. But Why?

By Lisa Aliferis, KQED

Thu, Jul 31 2014

After years of double-digit rate hikes in health insurance premiums, California will see average increases of 4.2 percent in 2015 for people who purchase insurance through the Covered California exchange, the state's Obamacare marketplace.

It’s good news for consumers, but two of the top insurance officials in the state disagree about why it’s happening.

Covered California's executive director and other analysts pointed to specific factors for this moderate increase. For starters, enrollment was very strong in 2014, more than a million people. In addition, healthy people signed up, spreading the risk.

But the state's insurance commissioner, Dave Jones, sees a different force in play. He believes that a statewide ballot measure, Proposition 45, has insurers scared.

"Health insurers have hit the pause button" on rate hikes, Jones said Thursday, just hours after Covered California announced its 2015 rates.

Proposition 45, which voters will consider in November, would give his office the authority to reject excessive rate hikes. Jones believes insurers held their fire on 2015 premium increases so as not to create a backlash from consumers and enable the passage of Prop. 45.

“There’s no guarantee insurers will continue to” keep rate increases low without Prop. 45, Jones said. “That’s authority we still need.”

Peter Lee dismissed the idea that 2015 premiums are artificially low, saying that he had been involved in “deep actuarial reviews” with insurers and said that “the last thing we want is rebound rate hikes” in future years.

As part of the rate review process, regulators at the Department of Managed Health Care and Jones’ Department of Insurance will review rates in the coming weeks to ensure they are neither too high, nor too low, Lee said. If premiums were set too low, an insurer might not have sufficient resources to cover the health care costs of its customers.

Jones confirmed that his staff would look at this issue, but said he “can’t imagine that these rates are inadequate.”

When rates were introduced in May 2013 for Covered California’s opening year many experts said they were surprisingly low and thought those low rates might be a “loss leader” strategy, said UCLA health policy professor Jerry Kominski. There was a concern that rates were low to get people into the market and then “jack up prices” later, he said.

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