Health insurer Anthem Blue Cross will postpone its much-criticized plan to raise rates for some California residents who buy insurance on their own, after reaching a deal Saturday with state regulators.
Anthem's planned rate hike, which the state estimates would affect about 700,000 customers, averaged 25 percent and would have been as high as 39 percent for some.
Anthem Blue Cross of California, based in Thousand Oaks, agreed to postpone the increase from March 1 until May 1 so California could have outside experts review the company's complex and detailed plan filing, including data on the medical costs it expects to incur.
The California Department of Insurance had been working with Anthem since mid-November to get more information about the increase, Insurance Commissioner Steve Poizner said. He wanted to have experts comb through the company's figures to confirm the new rates comply with a 2006 state law that insurers spend 70 cents of every premium dollar on medical care.
"Medical cost inflation in California is in the 10 to 15 percent range, so I have a healthy skepticism how they can get to 39 percent" and comply with the law, Poizner said.
If they don't, he said, he will direct the company to reduce its prices, "or I will take away their license to sell insurance" in California.
He officially requested the delay on Monday, but said Anthem stuck to its position that the individual insurance plan had lost money last year and the rate increases were justified — until Saturday. The change of heart came after a week of extensive media reports about the rate hikes, harsh criticism from the Obama administration and two Congressmen scheduling a hearing to look into the rates on Feb. 24.
"They did the right thing today," Poizner said during a conference call. "These are huge, massive rate increases, very concerning to me and my team."
The insurance department, which doesn't have legal authority to regulate the rates insurers set, has hired consulting firm Axene Health Partners LLC of Southern California to work with actuaries within the department, review Anthem's rate proposal and determine whether it complies with the 70-cent rule. They should finish by mid-April.
"They are actuarially sound and in full compliance with all requirements in the law," said Brian Sassi, president of Anthem Blue Cross of California.
The company has blamed the increased rates on the recession, rising medical costs and more healthy people dropping out of the plan, leaving fewer premium dollars to cover costs. It has insisted that the situation shows the need for a health-care overhaul that requires everyone to have health insurance.
But Health and Human Services Secretary Kathleen Sebelius said Thursday "it remains difficult to understand" how premium increases of that size can be justified when WellPoint Inc. reported a $4.75 billion profit in the last quarter of 2009.
"While a two-month delay offers some temporary relief, what California families need is long-term health insurance security, so that they don't face sharply higher prices or fewer benefits," Sebelius said Saturday. "This rate increase underscores the urgency of passing real health insurance reform."
Anthem's plan comes as more people lose employer-sponsored health insurance — and more insurers start raising rates on individual customers.
"We are seeing some significant price increases from other companies" filing new rates for individual insurance plans, which cover about 30 percent of Californians, Poizner noted. He said he did not have details.
Consumers in at least three other states who buy their own health insurance are getting hit with premium increases of 15 percent or more. The Anthem Blue Cross plan in Maine is asking for increases of about 23 percent this year for some individual policyholders. Last year, they raised rates up to 32 percent.
Kansas had one recent case where an insurer wanting to raise most individual rates 20 percent to 30 percent was persuaded by state insurance officials to reduce the increases to 10 percent to 20 percent. The insurance department would not identify the company but said it was not Anthem.
And in Oregon, multiple insurers were granted rate hikes of 15 percent or more this year after increases of around 25 percent last year for customers who buy individual health insurance, rather than getting it through their employer.
While the California insurance department oversees individual plans and another California agency oversees managed care health plans, Anthem said the postponement would pertain to customers getting either type of insurance from the company.