HHS Deems Insurance Premium Hikes in 9 States Excessive

HHS Secretary Kathleen Sebelius has announced that health insurance premium increases in nine states are “unreasonable” under the rate review authority granted by the Patient Protection and Affordable Care Act (PPACA) (P.L. 111-148), which requires insurance companies to justify rate increases of 10 percent or higher.

The announcement was made after HHS determined, based on independent expert review, that two insurance companies have proposed unreasonable health insurance premium increases in Arizona, Idaho, Louisiana, Missouri, Montana, Nebraska, Virginia, Wisconsin, and Wyoming. The rate hikes would affect over 42,000 residents across these nine states. Sebelius has called upon these companies to immediately rescind their unreasonable rate hikes, issue refunds to consumers or publicly explain their refusal to do so.

New rate review report issued by HHS

Sebelius also released a new rate review report showing that, six months after HHS began reviewing proposed health insurance rate increases, health insurers have proposed fewer double-digit rate increases and states have begun to take an active role in reducing rate increases. In fact, since March 10, 2012, the justifications and analysis of 186 double-digit rate increases for plans covering 1.3 million people have been posted at HealthCare.gov, resulting in a decline in rate increases. In the last quarter of 2011 alone, according to the report, states have reported that premium increases dropped by 4.5 percent, and in states like Nevada, premiums actually declined.

In these nine states, the insurers have requested rate increases as high as 24 percent. HHS has deemed these increases unreasonable because the insurer would be spending a low percentage of premium dollars on actual medical care and quality improvements and because the justifications of the insurers for the premium increases were based on unreasonable assumptions.

It should be noted that most rates are reviewed by states and many states have the authority to reject unreasonable premium increases. In addition, since the passage of PPACA, the number of states with this authority has increased from 30 to 37, with several states extending existing “prior authority to new markets. The HHS report also shows that:

• Texas, Kentucky, Nevada and Indiana are reporting fewer requests for rate increases over 10 percent;

• California, New York, Oregon, and many others, have proactively lowered rate increases for their residents; and

• the rate review program has made insurance companies explain their increases, and more than 180 have been posted publicly and are open for consumer comment.

Optometrists vs. Ophthalmologists in Pennsylvania: Who Can Do What?

A new piece of legislation in Pennsylvania is causing friction between optometrists and ophthalmologists by attempting to limit the scope of practice for optometrists. Their roles often confused, optometrists are referred to as “doctors of optometry,” despite the fact that they do not possess a doctor of medicine degree, but four-year degrees. Optometrists commonly perform vision examinations and write prescriptions for contacts and eyeglasses. On the other hand, ophthalmologists are eye surgeons who possess a medical degree and have completed a one year internship and a three year residency. The current law on the Pennsylvania books was enacted over 30 years ago and states that the practice of optometry shall not include surgery, use of a laser, or injections to treat ocular disease.

However, as medicine has evolved, some other states have begun to include more treatments within the definition of optometry. Most recently, Kentucky has amended laws to permit optometrists to perform laser eye procedures and cosmetic work around the eyes. Supporters of the legislation argued that such expansion was essential to ensuring the availability of treatment for patients in the state where there are four optometrists for every single ophthalmologist. Other states, such as Nebraska, Texas, and South Carolina, are evaluating similar legislation.

The Pennsylvania legislation, House Bill 838, is the opposite of the Kentucky bill as it seeks to limit “palliative, therapeutic, rehabilitative [or] cosmetic [procedures] for conditions or disease processes involving the eye…utilizing lasers, cautery, ionizing or nonionizing radiation, scalpels, probes, needles or other instruments in which the human eye…is cut, drained, penetrated” to the practice of ophthalmologists only.

 Advocates of the bill contend that a medical school education and subsequent internship is essential to delivering safe eye surgery to patients and handling any systemic complications that may arise. One supporting ophthalmologist, Kenneth Cheng, stated that while “there are eye procedures that are easier and faster than they were years ago, citizens of Pennsylvania expect that anyone performing surgery on the eye, including laser surgery, has gone to medical school.”

Opponents of the bill, which include the American Optometric Society (AOS) and the Pennsylvania Optometric Association (POA), see the legislation as a “direct frontal attack” on the practice of optometry. The POA has declared the bill “unnecessary and redundant” and claims that the current law in place already bars optometrists from performing surgery. What some see as a defense against the expansion of the practice of optometry others see as a restriction that may technically bar more than just surgery. According to the AOS, the bill specifically lists the  technologies that may be used in the practice of optometry and requires legislative approval for the use of any future technologies or changes in care standards. The Pennsylvania Academy of Ophthalmology counters that the bill simply removes ambiguity from the original statute and does not narrow the current scope of the practice of optometry.

The bill was widely approved by the Pennsylvania House last summer and is awaiting action by the state Senate’s Professional Licensure Committee.