New Yorkers may not be allowed access to detailed documentation that health insurers have submitted to justify premium increases next year, state officials say.
The state Insurance Department is trying to determine how much, if any, of the filings by 79 insurers under a new state law will be available for public scrutiny, said John Powell, assistant deputy superintendent for health at the Insurance Department.
“We’re now going through the material to make those determinations on a case-by-case basis,” Powell said. “Our objective is to ensure the companies aren’t overstating their case when they insist that certain information is proprietary.”
One Rochester-area insurer, MVP Health Care, takes the position that the submissions represent privileged communications with regulators. And Jim Redmond, a spokesman for Excellus BlueCross BlueShield, said that, in general, rate or premium requests contain information that could damage the company’s competitive position if released.
Health premiums must now be authorized by the state under a “prior approval” law passed this year. The requirement applies to premiums for community-rated insurance plans, which are based on the claims of a pool of subscribers.
Health insurers last month submitted to the state their proposed premiums for 2011. The companies sent along thick tomes of supporting data, including claims information.
“We consider all conversations with regulators to be business confidential,” said MVP Health Care spokesman Michael Traphagan. MVP has proposed 2011 premium increases for its community-rated plans of 8 percent to 12 percent for large companies and 25 percent to 31 percent for smaller firms.
Excellus has proposed rate increases in the community-rated pool of 9.5 percent and 12.5 percent for 2011.
The overall rate of inflation, meanwhile, was 1.1 percent as of August, according to the U.S. Bureau of Labor Statistics. Medical-care inflation was 3.2 percent for the past 12 months, the agency said.
Powell said state officials and the insurers have discussed what might be considered proprietary and whether some information may be available elsewhere and hence not be privileged.
“It’s hard to answer what we will release,” Powell said.
“Medical trends data, for instance, is used by the industry and might not be protected.”
Camille Jobin-Davis, assistant director of the state Committee on Open Government, said the law allows documents that would be otherwise be made public to be exempted if they contain trade secrets or other information that could damage the company if they are released.
“This is somewhat new territory,” Jobin-Davis said of the health insurance submissions. “The case law isn’t extensive on this particular issue.”
Nancy Adams, president of the Monroe County Medical Society, said the organization understands the need for companies to protect such data. But, she said, the public deserves to know the basis for any decision about health premiums.
“The lack of transparency is concerning,” Adams said. “If a 12.5 percent increase is approved and yet only a 4 percent raise was justified, how is the consumer supposed to learn that? I would hope that once the rates are set that the state would release this information.”
Under the law, the Insurance Department has until Nov. 1 to decide on the premium requests.