Bloomberg Business
Zachary Tracer
January 6, 2016 — 12:48 PM EST
UnitedHealth Group Inc., the largest U.S. health insurer, said its rates for Obamacare plans in New York may be too low because the failure of a competing insurer last year might lead to shortfalls in payments designed to stabilize Obamacare markets.
In states like New York, health insurers participating in the Patient Protection and Affordable Care Act negotiate annually with regulators to set prices for coverage. UnitedHealth's rates were set anticipating risk-sharing payments designed to stabilize the new insurance markets, William Golden, the company's northeast region chief executive officer, said Wednesday at a state Senate round table in Albany. If the loss of a participant reduces the funds available to UnitedHealth, the company's rates in New York's Obamacare market may be insufficient, Golden said.
“I have rates that are substantially too low based on risk-adjustment payments not being paid,� he said in the meeting.
Others in the state's health insurance industry criticized the Department of Financial Services' rate-review process as well. Paul Macielak, who runs the New York Health Plan Association, said DFS let Health Republic charge too little for its plans.
“Prior approval is a failed state policy,� Macielak said. “As it currently exists, it provides the superintendent with unfettered discretion to set rates.�
Generous Benefits
Health Republic was charging far less than insurer HealthNow New York Inc., even though its benefits were more generous, HealthNow CEO David Anderson said, adding that regulators should have realized that the company's collapse was likely.
“To have rates lower and costs that were higher is not sustainable,� he said at the event. “I don't think you need to be a Harvard MBA to see that that.�
Troy Oechsner, who helps oversee health insurers at DFS, said the regulator makes sure rates are sound and supported by actuarial calculations. He said actuaries from DFS and Milliman Inc. had examined Health Republic's rates.
“We feel strongly that we did the right thing at the time, given the uncertainty of the market,� he said at the event.
UnitedHealth's Golden said DFS should have approved higher rates for his plans, given that uncertainty. State regulators required that UnitedHealth's New York rates take into account payments from the law's risk-adjustment program, Golden said. The program redistributes funds from health insurers who have low-risk, low-cost patients, to those with less healthy, more expensive customers.
The stabilization payments were thrown into doubt after regulators began shutting down Health Republic Insurance of New York in September because it was likely to become financially insolvent. With its failure, Health Republic won't be able to pay into the risk-adjustment program, reducing the funds available to UnitedHealth and other plans in the state.
“I would have loved to have sat in a room and said, ‘What's your confidence level that these risk-adjustment payments would have been paid?'� Golden said. “If we would have had that opportunity in July and August, based on the information that Troy just talked about, he would have said, ‘We're not as confident as we should be.'�
UnitedHealth fell 1.2 percent to $115.30 at 3:45 p.m. in New York. The stock gained 16 percent last year.
UnitedHealth requested a 22 percent rate increase for individual Obamacare plans. Instead, state regulators allowed the company to boost rates by 1.65 percent. The company also sells business under the Oxford brand, which requested a 5.32 percent rate increase, and was forced instead to cut rates by 12.25 percent.
The company has said it should have stayed out of Obamacare's individual markets until they stabilized. In November, UnitedHealth said it would record hundreds of millions of dollars in losses related to the business.
“It was for us a bad decision,� CEO Stephen Hemsley said at a December investor meeting in New York. It's not clear if the potential problems in New York are accounted for in the company's previously announced anticipated losses.