I am writing today to announce the closure of the New Mexico Independent. After three and a half years of operation in New Mexico, the board of the American Independent News Network, has decided to shift publication of its news…
While environmental activists played their part yesterday during demonstrations at the capitol building, going so far as to dress up as solar panels and to sing the tune of “You Are My Sunshine,” their counterparts, the anti-cap-and-trade contingency who has…
Roughly one quarter of University of New Mexico students are unimpressed with the state’s flagship public school, according to a survey that questioned college students about their higher education experiences.
As New Mexico officials prepare to increase oversight of health insurance rates—with one eye on an influx of federal cash and the other on impending health care reform rules—members of the Public Regulation Commission are already struggling with public pressure to crack down on rapidly rising rates.
PRC Commissioner Jason Marks said Tuesday that although state law already allows the Insurance Superintendent to reject unreasonable premium rate requests (under 59A-18-14.A3) but it doesn’t require it.
A provision in the statute Marks pointed to allows the Superintendent to reject an increase when “the benefits offered are unreasonably restricted in relation to the premium charged.”
“Probably the best reason for revising the (state law) is to give the insurance superintendent clear direction that it’s not something he can do, but something he should do,” Marks said.
Marks’ comments come as state lawmakers and other New Mexico officials are pushing for New Mexico to strengthen its rate-review process following the state Insurance Division’s approval in late April of a controversial 21 percent increase in what 40,000 New Mexicans pay in monthly premiums to health insurer Blue Cross Blue Shield of New Mexico.
The New Mexico Public Regulation Commission requested last month that the Insurance Superintendent suspend the rate increase and start another review, setting up a possible court challenge from Blue Cross Blue Shield New Mexico. The health insurer has threatened litigation if the rate increase is overturned.
New Mexico rarely—if ever—rejects rate hike requests
New Mexico hasn’t had much experience with rejecting health insurers’ rate requests. Records show that the state Insurance Division had approved Blue Cross and Blue Shield rate hike requests in each year going back to 2004.
The Independent’s examination of state records revealed that the Insurance Division approved Blue Cross Blue Shield of New Mexico’s rate hike request, even though the company did not provide documentation for financial losses and expense figures cited as justification for its rate hike request.
Feds want states to beef up regulatory oversight
Expect the discussion over how to improve the state’s rate-review process to grow beyond the handful of lawmakers and other state officials, especially if New Mexico wins the $1 million in federal grant money the federal government is offering states to help hold insurers accountable for unreasonable insurance rate increases.
Already some New Mexico officials are throwing out ideas on how to strengthen the rate review process.
“The state of New Mexico has no definition of what an unreasonable rate increase is and regardless of the model (of state health insurance exchange) we choose to enact we need to have something like this in the law,” said Sen. Dede Feldman, D-Albuquerque. “This is extremely important. The state has never turned down a rate increase request. That means there is no regulation of health insurance rates.”
Feldman and other state lawmakers say New Mexico shouldn’t wait until 2014 to define what ‘unreasonable’ means, but should address the issue during the upcoming legislative session. The federal health care law passed earlier this year empowers states in 2014 and afterward to reject “unreasonable” rate increase requests by health insurers.
What ‘unreasonable; means, and who gets to define it, would likely involve the usual input from lobbyists, advocates, medical professionals and the insurers themselves. Feldman counseled getting guidance on how to define ‘unreasonable’ from the U.S. Department of Health and Human Services and the National Association of Insurance Commissioners before New Mexico codifies anything.
Commissioners want the PRC to have more authority
Another change to state law Marks has advocated is giving the Public Regulation Commission the authority to hear appeals, and rule on them, after the New Mexico Insurance Division has granted or rejected an insurer’s request.
Currently, the Insurance Division has sole authority over requests to raise insurance premium rates, and challenges to them are made in New Mexico state court.
That reality made Marks and one other commissioner careful Tuesday about how they described the PRC’s action in the Blue Cross Blue Shield case. Both Marks and his colleague on the PRC, Commissioner Jerome Block Jr., said that the Public Regulation Commission had requested, not ordered, the Insurance Superintendent to suspend the Blue Cross Blue Shield rate increase.
“To the best of my knowledge, we have no authority to direct the superintendent to do anything in this case,” Block wrote wrote The Independent via e-mail. “To the best of my knowledge, we have no authority to direct the superintendent to do anything in this case.”
PRC Chairman David King agreed with the need for giving his agency more authority.
“All we can do is request” the insurance superintendent to suspend the request, King told The Independent. “We do appoint the Insurance Superintendent but we can’t keep re-appointing the Insurance superintendent. Once a person is appointed they can do whatever they want. They can’t be fired except for cause. It’s almost impossible to fire them. If they resign, that makes it a little easier.”
