“Congress passed the Affordable Care Act to improve health insurance markets, not to destroy them,” summarized Chief Justice John Roberts at the end of his landmark June 25th opinion in King v. Burwell. The decision upholds the right of people in states with federally-facilitated exchanges to get “premium tax credits”, the subsidies provided under the 2010 Affordable Care Act to help low and moderate income people afford health coverage.
Narrowly at issue in the case was a clause saying that subsidies are available in exchanges “established by the State”, leading to a legal challenge arguing that people in the 34 states that use healthcare.gov, the federally-facilitated marketplace, should not receive the subsidies. Chief Justice Roberts’s opinion, speaking for a 6-3 majority (Justices Scalia, Alito and Thomas dissented) makes clear that this language was a drafting error and totally contrary to the intent of Congress. Recent media interviews of those involved with drafting the law also support the decision.
In the 1990s, Chief Justice Roberts explained, New York and other states banned insurers from denying coverage or charging higher premiums to anyone due to their bad health. In response, many bought health coverage only when they got sick, forcing health insurers to increase premiums to account for an ever sicker risk pool, causing even more healthy people to drop their insurance (known as the “death spiral”). The ACA addressed this problem by adding two reforms necessary to make the system work: (1) a requirement that all Americans (with limited exceptions) maintain health coverage; and (2) the premium tax credits. In light of this history, Chief Justice Roberts said in his opinion, Congress could not have meant for residents of the 34 states not to get federal subsidies.
As a result of the decision, six million Americans will not be threatened with losing their coverage and health insurance markets are not facing chaos. But it’s also critically important that the ACA has turned a corner. The major legal challenges are over. A majority of Americans now support the law. As ACA supporters, we now have a new opportunity to increase our focus on making the law work rather than refighting the battles of 2009 and 2010.
New York’s Prior Approval law protects consumers
Each year health insurance companies in New York submit applications to the Department of Financial Services (DFS) that explain their requests to raise, lower, or maintain the premiums they charge consumers for health insurance coverage. Thanks to a strong state law, New York’s DFS can reduce rate increases proposed by health insurers if they find the proposed rate is “unreasonable,” “excessive” or “unfairly discriminatory.” Under the 2010 Prior Approval law, DFS may review rates in the individual and small group (2-50) markets. Most proposed rate increases will go into effect on January 1, 2016.
DFS considers many factors when deciding whether to approve a rate proposal, including the costs of medical care and prescription drugs and the insurer’s past claims experience and financial condition.
Consumers, consumer groups, and small businesses can submit comments to challenge rate proposals that they believe are too high, but the time period to comment is extremely short. Comments must be submitted within thirty days after the insurer’s filing is posted on the DFS website.
The rate increases began to be posted on June 2. Check the DFS website (myportal.dfs.ny.gov/web/prior-approval/rate-applications-by-company) to get the exact deadline for your own health insurer. Many comments are due before July 2nd.
You can make a difference!
Last year, many consumers were faced with double-digit rate increase proposals, but consumers weighed in and the average rate increases were almost cut in half.
In 2014, DFS reduced the average proposed rate increase from 12.5% to 5.7% for consumers on the individual market and from 13.9% to 6.9% on the small group market, saving policyholders in New York an estimated $1 billion!
This year, many consumers and small businesses are again facing rate increases over 10%. The weighted average for rate increases is 13.5% on the individual market and 14.3% on the small group market. Increases like these can seriously cut into family budgets and small business owners’ ability to provide health care for their employees.
What You Can Do:
1. Write a comment challenging your rate increase. You can do this online, through the DFS web page, or you can send it in by regular mail. The DFS web page shows you how.
To comment online:
- Go to https://myportal.dfs.ny.gov/web/prior-approval/rate-applications-by-company
- Find your insurance carrier in the left column and click
- Go to “Pending Applications” and “Under Review” in the right column
- Click on your plan – IND for individuals and SG for businesses
- Create an account and leave a comment
2. Get others to submit comments
- Share our Policy Brief on rate review with friends and family: http://hcfany.org/resources/issue-brief-you-can-weigh-in-on-next-years-health-insurance-premiums/
3. Get the word out on rate review and the need to act by writing a letter to the editor or through social media.
- Sample tweet: My insurance company wanted to raise my premiums by X% next year! I spoke up and you can too! http://on.ny.gov/1ALYFCs #RateReview @HCFANY
What Your Comments Should Say:
Your comments don’t need to be long or complicated. DFS wants to know how a premium increase would affect your life. A short explanation is fine. You may want to include:
- The name of your insurance company and plan
- How a premium increase would affect you and those covered by your plan
- What changes you would have to make to afford the insurance
- Whether you are likely to keep health insurance if the increase goes through
Your Comments Really Matter!
With the launch of the health insurance exchange set for October 1, the advocacy community is buzzing with questions on how to quickly and effectively improve the public’s understanding around what are currently considered to be very mysterious topics for most: “insurance exchanges,” “premium tax credits,” and let us not forget the big one, “Obamacare.”
The good folk’s at Consumer’s Union recently decided to tackle one of the big ones – premium tax credits. They have released a report with findings from three rounds of consumer testing in three states (Maryland, Oklahoma, and Utah) on how to help consumers understand this topic.
The report is great at pinpointing the information that regular folks respond to and explaining how to break down what is essentially complicated IRS information in a way that is understandable to most. Best of all, they have created some really great templates for brochures, a worksheet, and a timeline graphic that folks can tweak and distribute themselves. Very cool.
Thanks to the Affordable Care Act (ACA), more than 1 million uninsured New Yorkers will newly have access to affordable health insurance options starting this fall. That’s a lot of folks who will need to wade through a lot of new information in the coming months.
HCFANY will be holding a briefing in New York City on Thursday, March 7th at the Interchurch Center from 9:00 am – 11:30 am to go over the necessary public outreach and enrollment efforts that will need to happen in order to ensure that the greatest number of New Yorkers benefit from the ACA. Specifically, we will be going over the following questions:
- How will New Yorkers learn about new health coverage options?
- How is New York State going to reach out to and sign up the uninsured?
- What will individuals, families, and small employers in New York l need to know?
- What’s to be gained if we do it all right (…and at risk if we don’t)?
- What can our elected officials do to help make it go smoothly?
- How can groups across New York contribute and participate?
This meeting is open to all New York members, allies, colleagues and new friends in the NYC area.