Anthem is California's largest for-profit health insurer. (David McNew / Getty Images )
California's largest health insurers are raising average rates by about 8% to 14% for hundreds of thousands of consumers with individual coverage, outpacing the costs of overall medical care.
The cost of goods and services associated with medical care grew just 3.6% over the last 12 months nationally, government figures show. But insurance premiums have kept climbing at a faster pace in California.
Insurers defended their rate hikes, saying they are based on their claims experience with the customers they insure and not just the broader rate of medical inflation. They also say that healthier members dropped out of the individual market as premiums rose and the economy worsened in recent years, leaving behind a group of policyholders who have higher average costs.
"We will continue to examine the fundamental issues at the heart of rising healthcare costs, including the prevention of chronic disease, increasing the quality of care and reducing unnecessary health expenses," said Darrel Ng, spokesman for Anthem Blue Cross, the state's largest for-profit health insurer.
Consumer advocates and others are skeptical, however, questioning whether insurers are doing enough to hold down costs. These latest increases follow years of 20% to 30% rate hikes for families that are at the center of a looming fight between the insurance industry and its critics over a proposed ballot measure seeking tougher rate regulation.
"Consumers should be outraged that premiums continue to grow faster than underlying costs," said Gerald Kominski, director of the UCLA Center for Health Policy Research. "There's help on the horizon for millions of Californians from health reform, but things may get worse before they get better."
Anthem has proposed raising premiums 9.6% to 13.8% on average, effective May 1 or July 1, for about 700,000 individual policyholders and their family members. The rate increases are under review by state officials.
Nonprofit Kaiser Permanente increased premiums 9% on average for nearly 300,000 customers last month.
Blue Shield of California, also a nonprofit, is boosting average rates by 7.9% for 265,000 members and by 8.9% for 56,000 members, both effective March 1.
Insurers in California must submit proposed rate hikes for review to determine whether they meet certain state requirements, but state officials don't have the authority to reject rate hikes for being unreasonable. But regulators have been challenging insurers' arithmetic in calculating rates.
Officials at the Department of Managed Health Care persuaded Blue Shield to lower a proposed 14.8% increase to the 8.9% boost. The agency said it disagreed with Blue Shield's projection for future medical expenses. The California Department of Insurance convinced Aetna, based in Hartford, Conn., to lower a 13.7% increase to 9.3% for 50,000 members last month.
"Many of the health insurance carriers have projected significant increases in medical costs and utilization, but those projections have not been borne out by experience," said Janice Rocco, the insurance department's deputy commissioner for health policy. "Therefore the rate is higher than it needs to be."
Rocco said some consumers may receive rebates in August. That would occur based on an upcoming state review of 2011 claims to determine whether insurers met a new federal requirement for spending at least 80% of premiums on medical care for individual policies.
Tom Epstein, a spokesman for Blue Shield, said the company consented to the change in its rates sought by managed health care officials because "we want to keep medical care more affordable for our members." In its filings to regulators, Blue Shield said "the cost of hospital services, physician services and prescription drug coverage for our individual members continues to rise."
In recent years, the rising cost of medical care and rate hikes for health insurance have been a major political issue that prompted congressional approval of President Obama's healthcare overhaul, much of which takes effect in 2014, and calls in California for tougher state regulation of health premiums.
Anthem tried to raise rates by up to 39% in 2010, sparking national outrage and helping Obama win support for his healthcare overhaul. The Woodland Hills company, a unit of WellPoint Inc., was forced to back down and accepted maximum rate increases of 20%. Last year, Anthem raised premiums 9% to 16% on average for individual policyholders.
Starting in October 2010, Blue Shield raised premiums by 23% to 35% on average for about 325,000 policyholders, a result of two separate rate hikes that spanned two years. Blue Shield also began issuing credits to customers if its net income exceeded 2% of revenue. The company said it returned about $450 million to individual policyholders last year as a result, which reduced members' rates by about 7%.