Just when consumers are finally getting a look at how health insurance companies conduct their business, the industry is racing to shut and lock the door. Buried deep in a "model law" for states to update health insurance regulation is a clause that would keep secret the companies' justification for exorbitant rate increases.
Why's this so bad? Because one of the few ways patients and consumer groups can tell whether a rate increase is justified is to closely examine the data-heavy actuarial reports that insurers use as their defense. In states with consumer-friendly insurance commissioners, some have found gross math errors in favor of the companies. (Simple mistakes? Maybe.) Without access to actuarial and other related data, consumers can't even hold an unfriendly insurance regulator to account, much less force the company to back down.
The "model law" is being drafted by the National Association of Insurance Commissioners, a private body of state insurance commissioners. It has long been criticized for being too cozy with the industry. The NAIC, however, has also drafted a lot of the regulations governing health insurance reform nationally, with the explicit approval of the Department of Health and Human Services. So what the NAIC says and does matters to every insurance policyholder.
Here's the industry-friendly secrecy clause tucked into the NAIC's model law, which most states would closely follow in drafting their own laws:
Each health carrier shall file with the commissioner annually on or before March 15, an actuarial certification certifying that the carrier is in compliance with this Act and that the rating methods of the carrier are actuarially sound. The certification shall be in a form and manner, and shall contain such information, as specified by the commissioner. A copy of the certification shall be retained by the carrier at its principal place of business.
(3) (a) A health carrier shall make the information and documentation described in paragraph (1) available to the commissioner upon request.
(b) Except in cases of violations of this Act, the information shall be considered proprietary and trade secret information and shall not be subject to disclosure by the commissioner to persons outside of the Department of Insurance except as agreed to by the health carrier or as ordered by a court of competent jurisdiction.
There is a lot of room for mischief in an actuarial certification, especially when the actuarial company depends on the insurance company for its pay. The insurance industry primarily uses the certifications as a shield against state oversight, especially any attempt to lower rates.
Under this clause, a state insurance commissioner could have trouble even telling the public why an insurance rate is unjustified, turning protective oversight into a he said-she said catfight. Given tens of millions in lobbying money employed on the insurance industry side, it wouldn't be an even battle. Consumers couldn't fight back against rates without data to back their argument.
If the secrecy clause stays in, states that already make such data public. like California, will find their legislatures swarming with insurance lobbyists pushing to put the data back in a closet, because the NAIC model law says to do it. The insurance lobby has repeatedly blocked state authority to deny or modify rate increases, so for a $35-million annual lobby, a little secrecy looks easy.
There is almost no such thing as a "trade secret" in a service industry like insurance. The companies don't need to keep their actuarial reports secret from other insurers--they just need to keep the data away from outraged consumers.
The NAIC's own consumer representatives oppose the industry secrecy clause. We hope the Department of Health and Human Services, which has strongly favored disclosure and transparency, will also weigh in. Otherwise, it will be up to the states to understand that this clause is a model of nothing except the lobbying might of the health insurance industry.
Consumers who'd like to fight back, at least in California, can start by learning more about Consumer Watchdog Campaign's Novermber ballot initiative. It would make insurance companies justify their rates before they go into effect, and reduce or retract rates if they're unjustified.