California Health Insurance Enrollments Rise, but Hispanics Still Lag


FEB. 19, 2014

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LOS ANGELES — With six weeks left in the open enrollment period for insurance under President Obama’s health care law, more than 828,000 Californians have signed up for private coverage through the state’s online health care exchange, state officials announced Wednesday.

Home to about 15 percent of the nation’s uninsured, California accounted for more than 20 percent of the 3.3 million people who enrolled in plans nationwide under the new law, the Affordable Care Act, during the first four months of open enrollment. About a quarter of the state’s enrollees have been young adults, ages 18 to 34, on par with national rates.

Still, enrollment has lagged among California’s Latinos, who make up more than half of the state’s uninsured population, according to estimates by the California Health Care Almanac. Covered California, the state-run online marketplace for health insurance, did not offer applications in Spanish until the end of December, and a Spanish-language site was dogged by translation errors — just one of a string of problems with the exchange’s website.

Through the end of January, only 21 percent of the people who had enrolled identified themselves as Latino, up slightly from 18 percent at the end of 2013, according to the data released Wednesday.

Latinos in California signed up at a slightly faster rate in January, but Peter Lee, the executive director of Covered California, said the exchange still needed to improve on Latinos’ enrollment. With six weeks left of open enrollment, Covered California has begun an aggressive campaign to beef up Latino enrollment.

“From absolutely Day 1, Latino enrollment has been probably the No. 1 priority of Covered California.” Mr. Lee said. “Have we executed perfectly? No. We’re getting better as we go, and we’re seeing results right now.”

The health care exchange plans to spend $8.2 million on Spanish-language media during the first three months of this year — more than twice what was spent from October through December. In addition, more than 4,000 Spanish-speaking enrollment counselors and insurance agents have been certified in the state.

“The key element is really promoting in-person enrollment,” Mr. Lee said, adding that the state now had “an extensive ground game in place,” referring to the enrollment counselors.

The exchange had also seen a modest uptick in sign-ups among young adults, whose enrollment is considered essential to keeping insurance premiums down because they are usually healthier and need fewer costly medical services. Mr. Lee also said he expected enrollment among young people to pick up as the March 31 deadline drew nearer.

“We are constantly doing focus groups, and a lot of guys and gals are saying they’re going to wait until the 31st to sign up,” he said. “Waiting until the last minute is certainly not preferred, but it’s not unusual.”

In addition to those who signed up for Covered California health plans, nearly 900,000 people had been deemed eligible for the state’s expandedMedicaid program, known as Medi-Cal.

More than 85 percent of enrollees in Covered California plans through January were eligible for subsidies, but Covered California did not have statistics on how many of the enrollees previously had no health coverage. About 80 percent of those who had signed up for coverage had paid their first month’s premium.

AMA to close news magazine

By Andrew L. Wang, Crain’s Chicago Business

Posted: August 12, 2013 – 6:45 pm ET

Tags: American Medical Association (AMA), Physicians

The American Medical Association, the country’s largest professional organization for physicians, is shutting down the news magazine it has published for 55 years.

The publication, which also operates a website at, has a print circulation of about 230,000 but has had trouble turning a profit over the last decade, amid declining ad revenue from drug companies, increased competition from other news sources and a steady migration of readers to the Internet.

“Over the last 10 years, AM News has been unable to generate an operating surplus. We’ve analyzed the situation exhaustively and do not foresee the trend improving,” said Thomas Easley, the association’s senior vice president and publisher of periodic publications, in a statement. “Despite the editorial excellence AM News consistently provides, it is not immune to the changes in the market, and we reached a point where we cannot continue down a path that is not sustainable from a business perspective.”

AM News will stop publication on Sept. 9, according to the statement. Its website also is shutting down, but the content will be available until the end of the year. The shutdown will affect 20 employees.

Revenue for AM News is about a third what it was a decade ago, Mr. Easley said in an interview. He declined to give specific figures on the publication.

According to the AMA’s latest annual report, publishing brought in $55.8 million in revenue for the organization in 2012, down from $65.2 million a year before. The decrease was due to an $8.7 million tumble in print display advertising, the annual report says.

Even so, publishing revenue, which includes proceeds from AM News and the Journal of the American Medical Association, still accounted for a larger percentage—about 20%—of the association’s total revenue last year, $273.9 million, than membership dues, which, at $38.6 million, made up just 14 percent.

Pharmaceutical advertising accounted for the bulk of revenue for AM News, Mr. Easley said. In addition to having to compete harder for ad dollars, AM News saw revenue slow to a trickle in recent years as several big-selling drugs went off patent and as drugmakers shifted focus to specialty products, rather than more broad-based blockbuster drugs, he added.

The shutdown does not affect JAMA, a research publication.

That publication and its related journals offer content unavailable elsewhere, as opposed to AM News, which occupied an increasingly crowded marketplace of health and medical news.

As such, Mr. Easley said, JAMA is on surer financial footing because most of its revenue comes from institutional subscriptions, with advertising only a secondary revenue source.

Mr. Easley said the AMA will make efforts to keep its membership up to speed on issues affecting their profession through two emails.

AMA Morning Rounds is a daily email that links to news stories from various news organizations, while AMA Wire is a weekly electronic newsletter geared to medical practice.

A subscription to AM News is a benefit of membership in the association. AM News’ print edition is published 24 times a year and focuses on news geared toward physicians, who make up 90% of its circulation. It started publication in 1958.

AMA to close news magazine” originally appeared in Crain’s Chicago Business.

Read more: AMA to close news magazine | Modern Healthcare 

Health care law could overwhelm addiction services

April 17, 2013 11:22:00 PM

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By Carla K. Johnson


CHICAGO — It has been six decades since doctors concluded that addiction was a disease that could be treated, but today the condition still dwells on the fringes of the medical community. Only 1 cent of every health care dollar in the United States goes toward addiction, and few alcoholics and drug addicts receive treatment. One huge barrier, according to many experts, has been a lack of health insurance.

But that barrier crumbles in less than a year. In a major break with the past, 3 million to 5 million people with drug and alcohol problems — from homeless drug addicts to working moms who drink too much — suddenly will become eligible for insurance coverage under the new health care overhaul.

The number of people seeking treatment could double over current levels, depending on how many states decide to expand their Medicaid programs and how many addicts choose to take advantage of the new opportunity, according to an Associated Press analysis of government data. The analysis compared federal data on the addiction rates in the 50 states, the capacity of treatment programs and the provisions of the new health law.

The surge in patients is expected to push a marginal part of the health care system out of church basements and into the mainstream of medical care. Already, the prospect of more paying patients has prompted private equity firms to increase their investments in addiction treatment companies, according to a market research firm. And families fighting the affliction are beginning to consider a new avenue for help.

“There is no illness currently being treated that will be more affected by the Affordable Care Act than addiction,” said Tom McLellan, CEO of the nonprofit Treatment Research Institute and President Barack Obama’s former deputy drug czar. “That’s because we have a system of treatment that was built for a time when they didn’t understand that addiction was an illness.”

But those eager for a new chance at sobriety may be surprised by the reality behind the promise. The system for treating substance abuse — now largely publicly funded and run by counselors with limited medical training — is small and already full to overflowing in many places. In more than two-thirds of the states, treatment clinics are already at or approaching 100 percent capacity.
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How health care overhaul may affect your tax bill

By John M. Gonzales

CHCF Center for Health Reporting

Published: Sunday, Apr. 14, 2013 – 12:00 am | Page 1D

If you’re among millions of uninsured Californians eligible for government-subsidized insurance, the ripples of health reform start with Monday’s tax deadline.

The government will use your return as its first yardstick for how much of a tax break it contributes to your health coverage. And if you don’t have government-mandated health insurance a year from now, a penalty will be added to your federal tax obligations.

These are among the ways the federal tax code will increasingly be at the forefront of health reform’s implementation. Other provisions are also kicking in as the countdown continues toward full operation of the Affordable Care Act on Jan. 1.

Employers already have started withholding a higher Medicare tax on high-income earners, for example. And 2013 marks the debut of a 3.8 percent tax on the net investment income of high earners.

The provision that will provide the biggest boost to taxpayers is the one that offers subsidies for uninsured people who obtain coverage through new insurance exchanges.

“It’s a tremendous deal for the people who are currently uninsured,” said Larry Levitt, senior vice president for special initiatives at the California-headquartered Kaiser Family Foundation.

“That’s not to tell you that the coverage will be free. The coverage will come with deductibles and co-pays,” said Levitt. “It will start with your current tax return, and ask everyone (to give notice) if their circumstances have changed.”

The subsidies also could create a good deal of confusion for participants in the exchanges, and in some cases come back to haunt. If your income goes up substantially during the year, for example, you could have to give back all, or some, of the tax break.

Oscar Hidalgo, spokesman for Covered California, the state’s health reform insurance exchange, said staff members are shaping plans to work with enrollees “to report changes in income that may change the amount of their subsidy.”

Even if enrollees promptly report such changes to the insurance exchange, though, they could still receive an unexpected tax bill, said Levitt.

For example, if an exchange enrollee was unemployed during the beginning of 2014, he would receive a substantial subsidy for insurance. If he then got a job with health insurance that paid about $46,000 a year, there would be no way for the government to recover the subsidy until taxes were filed.

Such an enrollee wouldn’t literally get a bill in the mail, but the Internal Revenue Service would reconcile that benefit on his next tax return, creating a tax liability.

Currently, the reduced tax credit amounts that people could have to give back are capped according to a sliding scale. They range from $300 for a person making about $23,000, to $1,250 for someone making about $45,000. However, there is legislation pending that seeks to remove the caps entirely.

Of course, the subsidy could also work to someone’s benefit. If a person fell upon hard times and made less money, or lost a job, his tax credit would increase.

“There undoubtedly will be cases where people get either pleasant, or nasty, surprises,” said Levitt.

“These are all new things for people,” he said. Health reform “will ultimately provide a lot of benefits, but it’s also going to generate a lot of confusion.”

The tax penalties, which won’t be assessed until 2015, are tied to the “individual mandate,” the linchpin of health reform that the Supreme Court ruled constitutional in the summer.

The mandate operates on a principle of personal responsibility – and the government’s belief that average Americans will buy into the expansion of health coverage as long as it’s affordable.

President Barack Obama’s health reform law is designed to boost the availability of coverage in two ways: through the establishment of mostly federally funded, state-run insurance exchanges like Covered California; and through an expanded version of Medicaid, or Medi-Cal in California.

Uninsured Americans, in turn, are obligated to participate, either by buying insurance in the exchanges, or, if low-income, by signing up for Medicaid (Medi-Cal).

If some of the uninsured don’t participate, those who do buy in will wind up shouldering the cost burden for their care. So the government thinks those who choose to remain uninsured should pay a tax penalty.

The penalties will range from $95 in the first year to at least $695 in later years.

The Congressional Budget Office and federal Joint Committee on Taxation estimate that some 30 million non-elderly residents will remain uninsured by 2016.

There will be multiple exemptions, including one if your insurance premium in the exchange exceeds 8 percent of income.

The CBO estimates that only one-fifth of the 30 million uninsured in 2016 will actually be subject to the tax penalty.

To get people statewide informed about the new insurance options, Covered California has initiated a $43 million outreach campaign.

It includes a direct outreach effort that has compiled a 13-page list of institutions that want to participate. School districts, community clinics and churches are seeking grant funds that require them to reach into their communities and provide information on how to enroll.

John M. Gonzales is a senior writer at the CHCF Center for Health Reporting. Based at the USC Annenberg School for Communication and Journalism, it is funded by the nonpartisan California HealthCare Foundation.

© Copyright The Sacramento Bee. All rights reserved.

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Insurers Flock to Private Exchanges While States Grapple With Obamacare Marketplace


The exchanges work like those that are expected to be operational in states under the Affordable Care Act next year in that they offer consumers more choices plus people who buy coverage are “empowered to make the choice that is right for each individual,” benefits consultants say.

“With 56 percent of employers considering a private exchange to provide benefits to their active employees or retirees, the transformation of the U.S. health care landscape is well under way,” saidDavid Rahill, Mercer’s president of health and benefits.

Under the Affordable Care Act signed into law by President Obama, millions of Americans in January of next year who have no coverage will receive federal subsidies of about $5,000 to help them buy coverage from health insurance companies that sell individual and small group policies. That subsidized coverage will be offered on exchanges as well but those marketplaces will be operated by each state or the federal government or a partnership between state insurance administrations and the U.S. Department of Health and Human Services depending on the state.

But in the private sector, the exchanges can work with so-called “insured plans” that tend to be sold to individuals or small businesses or self-insured plans that are typically offered by large companies.

Mercer rival Aon Hewitt, for example, has said its exchange launched last year that each employer in the exchange decides on the subsidy or “credit” that each worker will get to purchase coverage. Then, the employees take to the exchange to select their coverage. The subsidy will vary from employer to employer.

Critics of the exchange approach say it’s a way for employers to freeze the amount of money they provide to workers by essentially giving them a chunk of money and telling them to “go buy their own health care” with no promise that the amount offered to workers will rise or keep up with medical inflation in the future.

Mercer, however, sees the exchange approach as an “attraction and retention tool” for employers who will have more flexibility while their workers will have more choices. Mercer’s marketplace is at

Aon Hewitt has described its exchange will turn “selecting health benefits into a retail shopping experience” akin to (AMZN), or Orbitz (OWW).  More than 100,000 workers from employers such as Sears Holdings (SHLD) and Darden Restaurants are already using the Aon Hewitt exchange.

“This year, we were able to offer a broader array of health care choices than we have in the past, giving our employees the flexibility to choose the level of coverage that best meets their needs at a price they could afford,” Danielle Kirgan, senior vice president of total rewards and shared services at Darden Restaurants said in an Aon Hewitt statement.

Industry data shows an even faster growing participation rate on the horizon. The firm said two-thirds, or 66 of large employers are “considering moving” to a retiree exchange in the next three to five years while 28 percent of employers plan to move active employees into an exchange during that same time frame.

“A well-constructed private exchange can benefit employees, employers and insurers,” said Ken Sperling, Aon Hewitt’s national exchange strategy leader. “Many of these insurance companies experienced positive enrollment results in the Aon Hewitt Corporate Exchange last fall so it is not surprising to see growing carrier participation in private exchanges for 2014.”

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Affordable Care Act Requires Americans Take a More Active Role in Health Care Decisions

TurboTax offers free online tool to help people understand impact of new health care reform

Published: Friday, Mar. 29, 2013 / Updated: Friday, Mar. 29, 2013 08:05 AM


In a series of nationwide focus groups conducted by Intuit TurboTax®, a majority of consumers who participated lacked awareness of their new health insurance options under the Affordable Care Act, sometimes referred to as “Obamacare”. In addition, a most of them did not know if they would qualify for financial assistance to help cover the cost of health insurance.

In October 2013, federal and state Health Insurance Marketplaces are scheduled to open and an estimated 30 million uninsured Americans will need to make healthcare decisions that will impact both their personal and financial well being.

TurboTax now provides a simple, free online health care calculator, available on the TurboTax Blog, that helps people understand whether they may be eligible to purchase insurance through the new Marketplaces and if they qualify for financial assistance.

“Consumers who take a more active role in their healthcare decisions get the best outcome for both their health and their wallet,” explains Jane Sarasohn-Kahn, Health Economist ( and Advisor to the American Tax & Financial Center at TurboTax. “We encourage Americans to be engaged in their healthcare decisions starting now. Research shows that Americans spend much more time researching the purchase of an automobile compared with seeking information on picking their personal physician. Isn’t it worth investing a few hours over the next few months to get the best health care for you and your family?”


Balancing care and out of pocket expenses

The need to engage now in healthcare is especially critical for individuals and families who will fund health insurance through a combination of government subsidy (delivered as a tax credit starting in 2015) and monthly out of pocket expenses.

Based on analysis by the American Tax & Financial Center at TurboTax, a family of four earning roughly $50,000 would be eligible for an estimated $7,500 subsidy beginning in 2014, which would cover approximately 70 percent of their insurance premium. In this case, the family would be responsible for paying the remaining monthly premium of approximately $282 per month.

“The majority of families need to understand this will likely impact their monthly budget in some way,” added Sarasohn-Kahn. “U.S. consumers need to take on the role of ‘health consumers’ as they assume more responsibilities for choosing health plans based on the level of services covered by a health plan compared to the costs of the premiums and copayments under the different plans being considered.”

For the estimated 40 percent of households living paycheck-to-paycheck, the additional monthly payment for healthcare may seem out of reach. However, families will need to weigh the benefits of preventive care, and the potential costs of emergencies and existing chronic conditions managed by people in their families. In 2010, the average cost of an emergency room visit was $1,349.

While implementations of the new health care law don’t begin until October, this is a good time to start understanding it and preparing. For more information on the Affordable Care Act and its financial impact, visit the American Tax & Financial Center at TurboTax.

About The American Tax & Financial Center at TurboTax

Established in November 2012, The American Tax & Financial Center at TurboTax provides objective and independent data and insights on tax and personal finance trends. The Tax Center is now available to provide taxpayers, policymakers and media with resources and expert commentary on the impact of taxes on U.S. consumers.

The center’s primary goal is to help Americans in understanding financial matters so they can make informed financial decisions. The center educates and advocates for individuals by helping them take ownership of their financial future. For more information, visit The American Tax & Financial Center at TurboTax at

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3 charts on sequestration, healthcare innovation and the Affordable Care Act

March 27, 2013 9:00 am by Deanna Pogorelc | MEDCITY News

On Monday, the sequestration cuts are set to touch down on Medicare, causing a 2 percent drop in reimbursement payments made to doctors, hospitals and other providers.

Dr. Paul Keckley, executive director for the Deloitte Center for Health Solutions, wrote in a memo earlier this month (PDF) that providers should expect the reductions to affect their Medicare and EHR Meaningful Use payments starting mid-April.

The so-called sequester – $85 billion worth of federal spending cuts for 2013 – will impact the implementation of the Affordable Care Act, but not as much as it will other areas of the government, Keckley wrote. $11 billion of the cuts will be to Medicare providers, but those reductions were capped at 2 percent. Medicaid, children’s health insurance programs and military benefits are not directly cut.

Here’s a look at some of the other areas where the ACA will feel the impact:


In terms of what that means for healthcare innovation, Keckley suggested that although the medical device, biotech and pharmaceutical industries will continue to pay user fees to the FDA, they may not receive the expected benefits, like timely product reviews and approvals.


The National Institutes of Health has said that cuts will likely trickle down to grantees who have been awarded research

funding. Keckley anticipates that could, in turn, create a riskier environment for private investors. Coupled with the potential for a slower regulatory approval process, that may push medical device and drug companies even more in the direction of streamlining their R&D, refocusing on emerging markets and seeking collaborations, he wrote.

But overall, these cuts are just more of what the healthcare economy has already been experiencing. ’It’s about the cumulative impact of cuts by employers, households, and the government’s health plans – Medicare, Medicaid, Children’s Health Insurance Program – that impact our system,” Keckley wrote.

For more in-depth coverage of the sequestration, check out the links below:

Medical research, FDA and mental health programs face budget bite

Sequestration and doctors: What you need to know

FDA chief: Sequester cuts threaten drug approval

Healthcare cuts from vaccinations to research

[Charts courtesy of Deloitte]

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Unhealthiest counties lead in preventable hospital stays

Healthcare Business News

Unhealthiest counties lead in preventable hospital stays

By Paul Barr

Posted: March 20, 2013 – 12:01 am ET

Tags: Connecticut, Delaware, Hawaii, Medicare, Public Health, Quality, Rhode Island, Wisconsin

The unhealthiest counties in the nation have the highest rates of preventable hospital stays, smoking and adult obesity, according to the 2013 County Health Rankings, a joint effort of the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute. The healthiest counties, meanwhile, had higher numbers of primary-care doctors.

The least-healthy counties experienced 82.8 preventable hospital stays per 1,000 Medicare enrollees, while in the healthiest counties the rate was 57.2 per 1,000. The rest of the nation’s counties experienced 74 preventable hospital stays per 1,000 Medicare enrollees.

The report’s authors also found that 24% of adults smoke in the least-healthy counties, compared with 16% in the healthiest and 21% in the other counties.

The differences in the rates of obesity were less pronounced, with 30% of adults in the unhealthiest counties being obese, while the rate was 23% in the healthiest counties. The rest of the nation’s counties had an obesity rate of 28%.

There was one primary-care physician for every 2,129 residents in the least healthy counties, and 1,491 residents for every primary-care doctor in the healthiest counties. The rest of the counties in the study had 1,978 people per primary-care physician.

The data yielded some unexpected results. The healthiest counties had a higher rate of excessive drinking at 17% when compared with the unhealthiest at 15% and the rest of the country at 14%.

This is the fourth year of the rankings, which were calculated using 25 factors, including those listed above, to rate counties in the equally weighted categories of length of life and quality of life. The healthiest and least healthy county data were calculated using the results of the states’ five most and least healthy counties, excluding 90 counties in which data were unavailable and 20 counties in four states that didn’t have at least 10 counties: Connecticut, Delaware, Hawaii and Rhode Island.

Read more: Unhealthiest counties lead in preventable hospital stays | Modern Healthcare

Health insurance exchange plans up for review in Washington DC

Written by: Stephen Vagus | Live Insurance News

Written on: March 19, 2013


Small businesses have a problem with DC health insurance exchange

Plans for a health insurance exchange in Washington D.C. has been facing some challenges in recent months, many of which are coming from small businesses. This week, the D.C. Health Benefit Exchange Authority reiterated that it was committed to establishing a working health insurance exchange for Washington D.C., noting that small businesses would be forced to purchase coverage from the exchange program. The committee did, however, announce that it would be working to delay the mandate requiring these small businesses to purchase their coverage.


Exchange board considering delaying requirements on small businesses 

Under current law, all small businesses in Washington D.C. must purchase coverage through the region’s health insurance exchange when open enrollment begins in October of this year. Small businesses have been somewhat opposed to this mandate due to concerns regarding the costs associated with the exchange system. While Washington D.C. is a special legislative district, it must still cover the costs of its health insurance exchange without relying entirely on federal assistance. This typically means that a surcharge must be levied on all policies sold through the exchange.


Some small businesses may not be required to participate in exchange until 2016

The D.C. Health Benefit Exchange Authority has taken note of the concerns that small businesses have and is currently considering delaying their mandatory inclusion into the health insurance exchange. If the committee decides to delay the mandate, a number of small businesses will not be forced to purchase coverage through the health insurance exchange until 2015. Some may not be forced to purchase coverage through the exchange until 2016.


Health insurance continues to cause strife throughout the US

Health insurance continues to be a problematic subject throughout much of the U.S. While lawmakers in Washington D.C. are eager to comply with the Affordable Care Act, they are also working to address the issues that small businesses have with the concept of an exchange. Many small businesses in Washington D.C. do not currently offer health insurance coverage to their employees, so being forced to do so by law is linked to major financial concerns for these companies.


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Affordable Care Act at 3: Holding Insurance Companies Accountable

By: Secretary Kathleen Sebelius | The White House Blog

March 19, 2013
04:15 PM EDT


Ed. note: This post was first published on the official blog of You can see the original post here.

Enacted three years ago, the health care law is making the insurance market work better for you by prohibiting some of the worst insurance industry practices that have kept affordable health coverage out of reach for millions of Americans.

As a former state insurance commissioner, I know that for too long, too many hard-working Americans paid the price for policies that handed free rein to health insurance companies. For more than a decade before the Affordable Care Act, premiums rose rapidly, straining the budgets of American families and businesses. And insurers often raised premiums without any explanation.

It wasn’t fair and it was costing you your hard-earned dollars, security, and peace of mind.

The Affordable Care Act is working to bring affordability and fairness to the marketplace by barring insurers from dropping your coverage when you get sick or placing a lifetime dollar limit on coverage. In 2014, it will prohibit discriminating against you or anyone with a pre-existing condition, such as high blood pressure, asthma, or cancer.

In an effort to slow health care spending and give all Americans more value for their health care dollars, the Affordable Care Act has brought an unprecedented level of scrutiny and transparency to health insurance rate increases by requiring an insurance company to justify a rate increase before it shows up on your bill, thereby preventing arbitrary or unnecessary costs. Insurers must provide clear information so you can understand their reasons for significant rate increases.

We know this is making a difference, and that the law is driving down health insurance premium costs in the private market by holding insurers accountable.

A report last month shows that since the rule on rate increases was implemented, the number of requests for insurance premium increases of 10% or more plummeted from 75% to an estimated 14% since the passage of the health care law. The average premium increase for all rates in 2012 was 30% below what it was in 2010. And available data suggests that this slowdown in rate increases is continuing into 2013.

Even when an insurer decides to increase rates, consumers are seeing lower rate increases than what the insurers initially requested. More than half of the rate requests for 10% or more ultimately resulted in customers receiving either a lower rate increase than requested or no hike at all.

In 2014, insurers will be required to report all proposed rate increases, not just those 10% or more, in the individual and small-group markets.

Furthermore, the rate review program works in conjunction with the 80/20 rule, which requires insurance companies to spend at least 80% (85% in the large group market) of premiums on health care, rather than administrative costs (such as executive salaries and marketing) and profits, or provide rebates to their customers. Insurers that did not meet the 80/20 rule have provided $1.1 billion in rebates that benefited about 13 million Americans, at an average of $151 per family.

Insurance benefits and costs also will become clearer to millions of Americans and small businesses starting on October 1, 2013, when they will have the opportunity to shop in a Health Insurance Marketplace in their state. You will be able to find information to make apples-to-apples comparisons of health plans by quality and price and buy the one that best fits your needs and budget.

Delivering smarter health care includes holding insurers accountable, and that is helping to hold down costs. In the past three years, we’ve seen the slowest growth in overall health care spending since the government started keeping records more than 50 years ago.

We still have challenges to face. But for the first time in recent history, we’re making real progress in driving down the rate of growth and driving up the quality of care.

Find out more about the Effective Rate Review Program:


Follow Secretary Sebelius on Twitter at @Sebelius.

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