By Tara Bannow

The Bulletin

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For more information on the review process, to view the rates and learn how to submit comments, visit: www.oregonhealthrates.org.

Oregon’s health insurers are proposing across-the-board premium changes for 2015 — from a nearly 16 percent increase to a 21 percent decrease — and experts say it’s just one symptom of today’s ever-changing health care industry.

“It’s kind of a new world now, post reform,” said Oregon Insurance Commissioner Laura Cali, referring to the 2010 Affordable Care Act, which implemented consumer protections for insurance plans, prohibited insurers from denying coverage for people with pre-existing conditions and required that they cover essential health benefits and preventative care at no cost.

The Oregon Insurance Division scrutinizes companies’ administrative costs, cost-containment measures, quality-improvement efforts and profitability to determine whether their proposed rates are justified. In the meantime, it posts all the information online and solicits public input on the changes.

After reviewing the proposals, the Insurance Division will hold hearings and impose revised 2015 premiums by Aug. 1.

Perhaps the most anticipated filing came from Moda Health, which captured more than 40 percent of sales in the individual market this year with its inexpensive plans, including more than 70 percent of plans sold through Cover Oregon. More than 95,000 Oregonians are currently covered under Moda plans.

Moda is requesting an average of a 12.5 percent increase in premiums for individual plans in 2015, the second-highest of any company.

In its filing, Moda acknow­ledged the changing premiums would create a “decline in our competitive position” in 2015, but still projected its membership would grow to 150,000.

Moda spokesman Jonathan Nicholas attributed the premium increase to changing federal subsidies under the Affordable Care Act and ongoing health care inflation.

“All of us at Moda are confident that we have for 2015 what we had in 2014 — the highest value product line in the market,” he wrote.

Actual premiums will change depending on the enrollee’s age and location. A 40-year-old in Bend, for example, would pay $249 for a silver Moda plan in 2015, under the proposal, and a 60-year-old would pay $529 for the same plan.

On the flip side, Oregon’s Health CO-OP is looking to slash its individual plan premiums by 21 percent in 2015. Ralph Prows, the CO-OP’s president and CEO, said the new rates were created after looking at the CO-OP’s spending on claims, its plan designs and judgments about the overall health of the population that will enroll in the future.

“This is really our more accurate assessment for 2015 of what we believe the costs for our health plans will look like for the population to be served,” he said. The CO-OP sold 447 individual plans this year outside of the state’s health insurance exchange, but sold plans to more than 1,800 individuals through Cover Oregon.

PacificSource Health Plans is also requesting a double-digit rate increase in 2015: 15.9 percent among individual plans, according to its rate filing with the Insurance Division. In an interview, PacificSource Chief Operating Officer Sujata Sanghvi said the company submitted revised rates that bring the average increase to 10.8 percent, which she said is necessary because of the amount of medical claims the company is paying and the health of the population it expects to cover in the future. She emphasized the company wants the rates to be fair while also being adequate to cover its claims.

“We’re not looking to potentially be at a loss that needs to be covered in the future,” Sangh­vi said.

Jesse Ellis O’Brien, a health care advocate with the consumer advocacy group OSPIRG, said the Affordable Care Act has created dramatic fluctuations in rates over the past few years, with insurers constantly changing their rates up or down to remain competitive. That’s exactly what’s happening this year.

“Some of the insurers that were on the high end of the market last year are proposing big reductions so that they can become more competitive,” he said, “and some of the other ones are raising costs or keeping them roughly the same.”

And while the Affordable Care Act has made it easier for people to switch health insurers if their premium shoots up, doing so could disrupt their access to care if, say, their doctors aren’t in the same network under a new insurer, Ellis O’Brien said.

Each year, OSPIRG reviews the companies’ proposals and singles out unusually expensive premiums for extra scrutiny. Last year, it told the Insurance Division it felt five of the proposed premium increases were too high because they did not take into account what would likely be lower rates of uncompensated care provided by hospitals and clinics, and, thus, savings that should be passed onto consumers. The Insurance Division ultimately lowered premiums across the board for 2014 by as much as 20 percent, a change Ellis O’Brien said saved enrollees $69 million.

The premiums insurers originally proposed in 2014 also did not properly account for the impact of federal and state programs designed to keep premiums down as insurers take on what could be a disproportionate share of sick enrollees, Cali said. Those programs end in 2016. Accounting for those programs also prompted the Insurance Division to reduce premiums from insurers’ proposals that year, Cali said.

Since the Insurance Division made its rate review process more transparent in 2010 — posting proposed premiums online and gathering public input — OSPIRG believes enrollees have saved more than $155 million.

Cali emphasized the rate review process is all about making sure consumers are paying a fair price and insurance companies are making enough to cover their costs, and not too much extra.

“We want to make sure these companies do collect enough so that they can continue to pay claims, but certainly not so much that they’re overcharging the public,” she said. “It is that balance.”

— Reporter: 541-383-0304,

tbannow@bendbulletin.com

Editor’s note: This story has been corrected. In the original version, Sujata Sanghvi’s position at PacificSource Health Plans was misidentified. The Bulletin regrets the error.

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