Issues

Pennsylvania Insurer Seeks to Boost Obamacare Rates by 48.1 Percent

Insurer has already lost $812 million in 2014

Doctor
Doctor listens to patient's heartbeat / AP

Highmark Inc., one of the ten largest health insurers in the United States that serves Pennsylvania, is seeking to boost rates on its Obamacare plans by 48.1 percent next year, the Pittsburgh Post-Gazette reported. The hike is the highest sought among health insurers in the state.

"The Blues affiliate reported losing a total of $812 million on the insurance line in 2014 and 2015, and said losses would reach another $500 million by July," the article states.

Highmark also filed a lawsuit against the federal government for failing to cover $223 million in losses in 2014 as part of the "risk corridor" program, which was supposed to cushion insurers’ losses in the first years of the program.

According to Alexis Miller, senior vice president of individual and small groups at Highmark, coverage has been costlier for those using the marketplace because they have higher medical bills.

"Our experience with this population is that they are indeed sicker," Miller said. "They utilize more services. For every dollar in premiums, there is $1.19 in claims, and that’s not sustainable."

"Newly insured people under the ACA had inpatient hospitalization rates 57 percent higher, 49 percent higher rates of chemotherapy treatment for cancer, and 43 percent higher rates of congestive heart failure when compared with commercially insured members, Highmark President and CEO David Holmberg said earlier this month," the article explains.

In addition to Highmark, UPMC Health Plan requested rate increases of 16.2 percent and 0.9 percent for two plans offered on the government exchange. "Other top rate requests include First Priority Life Insurance Co.; 38.8 percent; Geisinger Health Plan, 41.23 percent; and Geisinger Quality Options, 40.68 percent," the article states.