Review and Disclosure of Health Insurance Premium Changes: State and Federal Roles After PPACA
October 21, 2011
The Patient Protection and Affordable Care Act of 2010 (PPACA) requires annual review of premium increases and disclosure of those increases determined unreasonable beginning in September 2011. Under PPACA, each state will conduct these reviews for individual and small-group health insurance unless the federal government concludes they do not have an effective review program. As they did prior to PPACA, state laws govern whether rates go into effect and establish the parameters of regulators’ authority. This Forum session reviewed state and federal roles in the rate review process. A federal official and former state insurance regulator from CMS’s Office of Consumer Information and Insurance Oversight discussed the PPACA requirements for state and federal governments and insurers, how those requirements are being carried out, and their implications for consumers. Insurance regulators from three states discussed the premium rate review process in their states, including the authority, practices, and resources available, as well as any changes related to PPACA requirements and the availability of grant funding.
Director of Rate Review
Center for Consumer Information and Insurance Oversight (CCIIO)
Centers for Medicare & Medicaid Services
Guenther H. Ruch
Wisconsin Office of the Commissioner of Insurance
Chief Market Insurance Examiner for Market Regulation, Life and Health Division
Bureau of Insurance
Virginia State Corporation Commission
Thomas Abel, MS
Supervisor, Rates and Forms
Colorado Division of Insurance
For more information on rate review disclosure and PPACA requirements, see "Individual and Small-Group Market Health Insurance Rate Review and Disclosure: State and Federal Roles After PPACA" (Issue Brief No. 844, September 28, 2011).
U.S. Government Accountability Office (GAO), "Private Health Insurance: State Oversight of Premium Rates," GAO-11-701, July 2011.
Mark Newsom and Bernadette Fernandez, "Private Health Insurance Premiums and Rate Reviews," Congressional Research Service, Order Number R41588, January 11, 2011 (available upon request to congressional staff).
Sabrina Corlette and Janet Lundy, "Rate Review: Spotlight on State Efforts to Make Health Insurance More Affordable," Henry J. Kaiser Family Foundation, December 2010, Appendix A.