U.S. Department of Health and Human Services: Rate Review Annual Report September 2013. Executive Summary


The Affordable Care Act continues to bring transparency and scrutiny to health insurance rate increases.  Because of the law, the Department of Health and Human Services (HHS), along with states, is working to hold insurance companies accountable by requiring them to document, submit for review, and publicly justify rate increases of 10 percent or more.  Additionally, the Affordable Care Act continues to provide states with rate review grants to enhance state efforts to review proposed increases in health insurance rates and make information and decisions about rate increases available to the public.

An analysis from the Office of the Assistant Secretary for Planning and Evaluation (ASPE) of rate review activities in calendar year (CY) 2012 shows that the rate review process saved consumers approximately $1.2 billion on their premiums when compared to the amount initially requested by insurers. These savings accrued to 6.8 million people.   In the individual market, the average rate request increase dropped by 12 percent (from 8.1 percent to 7.1 percent) after rate review, saving consumers an estimated $311 million. Similarly, in the small group market, the average rate increase request declined by 19 percent (from 5.8 percent to 4.7 percent), saving consumers an estimated $866 million after rate review.  This is in addition to the $500 million in medical loss ratio rebates for 2012, for a total $1.7 billion in savings in 2012.   

Moreover, insurers were much less likely to submit requests for rate increases of 10 percent or more in 2012 than in previous years, and it is likely that this change in issuer behavior is a result of the Affordable Care Act policy that requires requests for increases of 10 percent or more to be justified and reviewed.  In 2012, 26 percent of requests for rate increases in the individual market were for an increase of 10 percent or more, significantly lower than the 43 percent requested in 2011.  This change in issuer behavior resulted in additional savings to consumers on top of the direct savings estimated above.

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