New York health insurance companies propose rate increases

Jun 29, 2017

New York State is now accepting public comments on proposed health insurance rates. These are rates for plans sold on the state's exchange.

Although each person's specific rate depends on a lot of factors, New York insurers generally want to raise premiums on individuals and small groups. Companies are asking for permission to charge individual customers 16.6 percent more, on average. For small group customers, the request is a 11.5 percent increase.

The premium requests don't apply to insurance plans that people get through their employers; about half of New Yorkers are covered this way.

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Bob Hinckley is chief strategy officer with the not-for-profit insurer CDPHP. He also used to work in the administration of former Gov. George Pataki. His company offers both small group plans and individual plans. It's asking to raise premiums for people on the individual market by 15.2 percent.

Hinckley said that's due to three things:

One - New York may increase requirements for what health insurance has to cover.

Two - "The rising cost of health care in general," Hinckley said. "We're seeing a great amount of consolidation in terms of hospitals merging [and] hospitals buying up physician practices." He specifically mentioned the Hudson Valley and Capital regions.

He also mentioned the cost of prescription drugs, which is often blamed for rising premiums. "Consumers need to know how much of the dollars that are going for prescription drugs are being spent on research and development and how much are being spent on marketing and public relations and lobbying," he said. "And profit."

Hinckley likes New York's new plan to cap what the state's Medicaid program pays for prescription drugs. While that doesn't apply to commercial insurance plans, he thinks it's a good first step to getting better information out there.

But Elisabeth Benjamin, vice president for health initiatives at the advocacy group Community Service Society of New York, said insurers can bargain with with drug companies.

"These carriers tend to use these pharmacy benefit managers," she pointed out. "They should be getting the pharmacy benefit managers to make good deals for them. They have a lot of bargaining power."

Three - Hinckley said the state's changing what's called the "risk adjustment pool." That's the money used to shore up insurers who have sicker customers. According to Hinckley, upstate insurers with sicker patients will end up getting less of that money.

But Benjamin said the big changes in risk adjustment came last year.

"It's not clear to me that this year would be an important year on that front to justify huge price increases," she said.

As for any potential changes to the Affordable Care Act, Hinckley said the requests weren't really affected by uncertainty over how Congress may act. "The state basically required [health plans] to assume present law maintains through 2018 in filing our rate requests," he said.

On its website, the state Department of Financial Services does say that it asked for "estimates as to how the impact of a potential repeal of the individual mandate and the lost of Cost Share Reduction (CSR) funding would affect rates." (CSR money lowers the cost of insurance for some customers.) These are only two of the changes Congress could make to health care insurance.

The public comment period for the requested premium increases ends next month. After that, the state will announce what increases -- or decreases -- it approves.