Congressional Republicans Request Early Premium Details on Federal Marketplaces

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By Sara Hansard  


Citing the need for consumers to have accurate information as soon as possible, a group of congressional Republicans July 22 asked the Department of Health and Human Services to release information on what the rates will be for the federally run individual marketplaces in 34 states.

In particular, the lawmakers asked for the premium filings received by HHS for insurers applying to offer qualified health plans (QHPs) in the 34 individual federally facilitated marketplaces.

A letter from seven Republican leaders of the Senate Health, Education, Labor, and Pensions (HELP) Committee and the House Energy and Commerce Committee to HHS Secretary Kathleen Sebelius said it is essential that the pricing information be made public “as soon as possible for the millions of Americans who will be impacted by this law.”

HHS officials have said the agency will not release the premium information until September, and it is communicating with insurers that have filed rates that appear to be higher than normal (see previous article). Initially, HHS had said it would allow all qualified applicants to offer plans in the federally facilitated marketplaces in 2014.


“Delaying the release of premium information until September will only serve to limit the amount of time individuals and families have to budget for the substantially higher insurance costs many will face,” the Republicans said.  




Guidance issued April 5 on the marketplaces to issuers in the federally facilitated and state partnership marketplaces said HHS will review and make certification decisions for the marketplaces between July 31 and Aug. 22; issuers will preview plan data for accuracy from Aug. 22 to Aug. 26; HHS will notify issuers of QHP certification decisions by Sept. 4; and HHS will enter into agreements with issuers between Sept. 5 and Sept. 9.

Under the Affordable Care Act, the individual and small group online health insurance marketplaces will open for enrollment Oct. 1. HHS will operate the individual marketplaces in 34 states, including seven states that are participating in state partnership marketplaces, and Utah, which is only operating its own state-based Small Business Health Options Program marketplace. Sixteen states and the District of Columbia are separately setting up their own state-based individual marketplaces, and they have separate timetables.

Delays Limit Time for Budgets

“Delaying the release of premium information until September will only serve to limit the amount of time individuals and families have to budget for the substantially higher insurance costs many will face,” the letter said. It was signed by Sen. Lamar Alexander (R-Tenn.), ranking member of the Senate HELP Committee; Rep. Fred Upton (R-Mich.), chairman of the House Energy and Commerce Committee; Sens. Michael B. Enzi (R-Wyo.), Richard Burr (R-N.C.), and Sen. Johnny Isakson (R-Ga.); and Reps. Tim Murphy (R-Pa.) and Joseph R. Pitts (R-Pa.).

Rates in the individual market are expected to increase as much as 30 percent to 40 percent on average in 2014, the letter said, citing a study conducted by the Republican staff of the Energy and Commerce Committee. Insurers have been planning for average premium increases for new customers in the individual market of 96 percent, with spikes as high as 400 percent, it said.

The Republican leaders said they are “equally concerned about the potential impact of premium increases on small businesses,” with polls showing that many small companies have frozen hiring or reduced the number of employees because of ACA. “For small businesses trying to offer insurance to employees, premium increases could mean further job cuts and lost growth,” the letter said. Publicizing insurance rates as soon as possible would give businesses time to plan, it said.

Negotiations with insurers “have been conducted behind closed doors, without assurances that a fair process has been observed or that the negotiations will result in better insurance products for consumers,” the letter said.

It requested information by Aug. 5 on all QHP filings; the methodology HHS used to determine when to negotiate with applicants; what information HHS shares with insurers; what incentives HHS uses to get insurers to change rates; and a list of insurers HHS has contacted to negotiate rates.

The Republicans also requested a staff briefing on the issues.

An HHS representative said the agency is “still reviewing the letter.”

Request Health Care on Bloomberg Law