Missouri: Bill passes to give insurance dept. authority to review/post rates...but not to change them

Don't get me wrong, this is great news from a transparency pov...

Coalition cheers Health Insurance Rate Review bill passage

The House followed the Senate’s unanimous approval of SB 865, sponsored by Sen. David Sater, with a 140-6 vote, moving the “Health Insurance Rate Review” bill to the Governor’s desk on Tuesday.

In addition to rate review, the bill will modify provisions regarding licenses issued by the Board of Pharmacy and covered prescription benefits, delineates procedures for PBMs with regards to MAC lists, and requires health carriers to offer medication synchronization services.

The advancement was cheered by Missouri Health Care for All (MHCFA), who believe the bill will bring more transparency to insurance premiums.

“Until now, Missouri has been the only state in the country where our Department of Insurance has no authority to review or publish the premiums being charged by health insurance companies,” said Jen Bersdale, MHCFA executive director. “Without this basic transparency, consumers have no way of determining whether the rates they are being charged are fair.”

Professor Sidney Watson, the Jane and Bruce Robert Professor of Law at Saint Louis University’s Center for Health Law Studies and a Missouri Health Care for All Board Member, pointed out that Missouri families are suffering under high premiums, especially in certain parts of the state.

...so I applaud the Missouri legislature for doing the right thing here with nearly-unanimous votes. HOWEVER, note the reference to reviewing and publishing the rates only.

Sure enough, when you read the actual wording of the bill itself:


The act creates the "Missouri Health Insurance Rate Transparency Act" to apply to health benefit plans, excluding large group market, long-term care, and Medicare supplemental plans, delivered, issued for delivery, continued, or renewed on or after January 1, 2018. Under this act, no health carrier shall deliver, issue for delivery, continue, or renew a health benefit plan until the rates for that plan have been filed with the Director of the Department of Insurance, Financial Institutions, and Professional Registration in the manner specified in the act. Rates shall be filed for excepted health benefits plans, as defined in the act, and grandfathered health benefit plans 30 days prior to use for informational purposes only. For all other plans, a health carrier may use rates on: (1) the date the Director determines such rates are reasonable, (2) the date the health carrier notifies the Director of its intent to use rates the Director has determined are unreasonable, or (3) 60 days after filing rates with the Director.

The Director shall determine by rule when rates filed by health carriers shall be made publicly available and shall provide a means by which the public can submit written comments concerning proposed rate increases. The Director shall review the proposed rate and accompanying documentation and determine whether the rate is reasonable or unreasonable. Within 60 days of rate filing, the Director shall provide the health carrier with written notice detailing whether the proposed rate is reasonable or unreasonable. If the Director deems the rate is unreasonable, the written notice shall specify the deficiencies and detailed reasons why the rate is excessive, inadequate, unfairly discriminatory, or unjustified. Within 30 days of receiving written notice that the proposed rate is unreasonable, the health carrier may amend its rate, request reconsideration, or implement the proposed rate. The health carrier shall notify the Director of its intention within 30 days of receipt of the written notice. If a health carrier implements a rate determined to be unreasonable, the Department shall make such determination public.

The Director shall publish final rates on the Department's website no earlier than 30 days prior to the first day of the annual open enrollment period in the individual market for the applicable calendar year.

In other words, like every other state, the Missouri Dept. of Insurance will finally have the authority to review the rate changes, publish them publicly, allow public comment on the changes and chastize the carriers if they jack up rates excessively...but they still won't be able to actually force them to lower the rates.

This is actually the case in many other states as well; some states can deny what they deem to be excessive rates, but I believe most of them can only try to shame the carriers into lowering them, which isn't the same thing at all. Don't get me wrong, this isn't necessarily a terrible thing; part of what got some carriers into trouble over the past couple of years was underpricing policies in order to snap up market share--or, in some cases, state regulators being a little too eager to keep rates lower than was actuarially justified.

Anyway, this is still a lot better than leaving the rate increases a complete mystery until November 1st, so I'll take it.