Health insurers for LI split on exchange fee changes for next year

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A federal appeals court has delivered a serious setback to President Barack Obama's health care law, potentially derailing subsidies for many low- and middle-income people who have bought policies. Photo Credit: AP / Jon Elswick

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Rate requests by health insurance companies selling to Long Islanders on the exchange show two trends for next year: About half are asking for a hefty increase in what they can charge for premiums, and about half are seeking an overall decrease in their rates.

Insurance companies request rates annually with the state Department of Financial Services, which then reviews and either approves or modifies them. A final decision for 2015 rates is expected at the end of August.

Overall statewide, insurers requested an average weighted increase of about 13 percent for next year, according to the DFS. A weighted average takes into account all products, on and off the exchange, across all regions in the state. According to department spokesman Matthew Anderson, rate requests for Long Island appear to be "roughly in line with the rest of the state, if not a point lower."

And, Anderson said, rate requests are often lowered.

"Very often, the rates that insurers put forward are reduced as a result of that review process," he said.

In 2013, the average rate request was 12.4 percent higher, which was reduced to 7.5 percent, he said. With the advent of the exchange, 2014 rates for individuals and families went down 53 percent on average.

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Rising costs, rising rates

Among the nine companies offering Long Islanders insurance next year on the exchange, five are seeking rate increases and four are requesting decreases.


Those seeking rate increases include some with the largest market share on Long Island.

Empire BlueCross BlueShield, which has the largest percentage of Long Islanders on the exchange -- 33 percent in Suffolk and 31 percent in Nassau -- and is fourth statewide, is seeking an overall weighted average increase of 18 percent. Fidelis Care, second statewide and on Long Island on the exchange, seeks a 7.1 percent increase. Health Republic, the top individual insurer on the exchange statewide and third on Long Island, seeks a 15.2 percent increase.

On the other hand, Affinity Health Plan, UnitedHealthcare, North Shore-LIJ CareConnect and Healthfirst -- which is not offered in Suffolk -- are requesting decreases. All have relatively small exchange market shares.

And three of the four insurers selling to Long Island's small businesses on the exchange are seeking rate increases. Health Republic, which dominates the small business exchange market on Long Island, is asking for a 6 percent increase; Oxford is seeking an 11.4 percent increase; and MetroPlus health plan is asking for a 29.82 percent increase. North Shore-LIJ is seeking a 14.46 percent decrease.

Companies seeking rate hikes said the requests are driven by their growing experience with the exchange and their new customers, increased costs and the Affordable Care Act.

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Empire said in a statement that its "rate filings reflect the rising cost of care, the new pool of customers, our experience with provider networks, new rating structures, and new taxes and fees."

A spokesman for Health Republic said those factors plus federal support that diminishes each year over three years helped determine its request. The rate increase is needed to "ensure its long-term sustainability" as New York's only not-for-profit cooperative plan, he said.

Charlene Maher, chief marketing officer for EmblemHealth, which seeks a 9.5 percent increase, said "the cost of delivering health care continues to increase, along with the complexity of administering" the Affordable Care Act. She said the "requested increase is a result of additional taxes, fees and benefit enhancements" required by the state and federal government.


Others seek decreases

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But others want to adjust their rates downward.

Affinity Health Plan, which has historically provided low-cost Medicaid insurance, requested a 12.61 percent reduction. Abenaa Udochi, Affinity's chief marketing officer, said in a statement that was "the right thing to do."

"When 2014 rates were filed for the New York health insurance exchange, every insurer estimated premium rates based on data and information such as past business history, claims experience, customer profiles and provider reimbursement," Udochi said.

Similarly, UnitedHealthcare, which had among the highest premiums on the exchange in 2014, requested a 5.8 percent reduction for individuals on the exchange.

North Shore-LIJ, which uses North Shore-LIJ's hospitals and associated doctors and is expanding affiliations with other hospitals in New York City and Westchester, is asking for a 0.85 percent decrease for individuals on the exchange.

"In essence we are holding the rates on Long Island," said president Alan Murray.

Murray said that the company hit its initial goal of 10,000 members and is "humming along."

"We wanted enough members to prove the concept," he said. "Our vision requires us to have affordable health care. If we're hitting the numbers, why raise rates?"

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