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.
The electrical utility PNM and other parties signed the Public Regulation Commission’s $72 million rate hike that passed the committee on July 28, accepting less than what they had originally asked for.
Blue Cross and Blue Shield of New Mexico attorney Paul Bardacke spent much of his time at last week’s Division of Insurance hearing on his client’s latest health insurance rate hike attacking Allan Schwartz, the Attorney General’s office’s independent expert who testified…
Controversy has surrounded the state’s approval of a 21.3 percent rate hike on 40,000 Blue Cross and Blue Shield of New Mexico health insurance policyholders, but the state Division of Insurance approved Presbyterian Insurance Company’s even larger, 24 percent health…
The state’s largest provider of electricity wants to raise rates on its half a million customers by 20 percent, saying its costs have risen dramatically. But after state regulators said the company didn’t provide enough information about those rising costs, PNM took its plea to the state Supreme Court.
The state Public Regulation Commission (PRC) declared the Public Service Company of New Mexico (PNM)’s electric rate hike filing to be incomplete last week, delaying approval at least until June 30, 2011.
The commission’s approval or disapproval of…
Theresa Becenti-Aguilar‘s top priority on the Public Regulation Commission (PRC) will be empowering PRC employees, she told staffers this week — but protecting consumers will be a close second, she said.
The Insurance Division’s negotiation of a controversial…
A planned public hearing on Blue Cross and Blue Shield of New Mexico‘s controversial health insurance rate hike may be delayed until September.
The company filed a motion July 2 with the state Insurance Division, saying the public hearing and division review of the rate hike should be delayed until the Supreme Court has ruled on the matter, because preparing for the public hearing would be time consuming and the court may toss the PRC’s decision to reverse approval of the hike. More …
Aetna has become the second health insurance company in California since April to scrap planned rate hikes, following revelations last week that “math errors” in the company’s application exaggerated justification for the proposed rate increase.
The company had sought a…
Blue Cross Blue Shield has asked the state Supreme Court to block the PRC’s decision to suspend a controversial 21 percent health insurance rate hike. The company says it complied with all regulations in pursuing the rate hike and negotiated with the Attorney General’s office and Insurance Division in good faith to arrive at the settlement. That settlement came after the state’s expert concluded the rate hike was unjustified and the company had “inflated” its losses.
Insurance Division officials fired former compliance director Aaron Feliciano after he refused to hire an unqualified candidate as chief investigator and complained to the Attorney General’s office about “unlawful or improper” acts by Division officials, Feliciano alleges in a…
PNM filed a request last week for approval of another 21.2 percent hike that would take effect in April 2011. But two PRC commissioners said Tuesday they would not be open to accepting a rate hike settlement before next year. The Commission’s go-slow approach with PNM contrasts with the Insurance Division’s rushed weekend deal with Blue Cross Blue Shield—before public hearings on that company’s request.
The Blue Cross Blue Shield New Mexico health insurance policyholder who signed off on last month’s controversial rate hike settlement, has asked the state Insurance Division to reverse its approval of that deal.
Jody Neal-Post submitted a…
Blue Cross Blue Shield of New Mexico did not provide the state Insurance Division with documentation for financial losses and expense figures cited as justification for last month’s controversial health insurance rate hike, Public Regulatory Commission (PRC) records show.
The company’s defense for failing to back up their figures with supporting evidence? Regulators did not ask for any.
Insurance Division staff have not required Blue Cross Blue Shield NM, or other health insurers, to submit documentation supporting rate increase requests, Blue Cross Blue Shield officials said, leading PRC Commissioner Jason Marks to describe the Division’s regulatory culture as “insufficiently skeptical.”
Rate hike application ‘not properly documented’
When the Attorney General’s office hired award-winning insurance rate analyst and former New Jersey insurance regulator Allan I. Schwartz as an independent expert to review Blue Cross Blue Shield’s rate hike filing, he reported that supporting documentation for most of the figures cited by the company was missing. And what little data was available, Schwartz concluded, contradicted the company’s claims.
The company’s requested rate hike was not justified, he concluded.
“The BCBSNM rate filing was not properly documented and supported,” Schwartz said in testimony to the Insurance Division March 2. “The filing did not provide sufficient documentation regarding numerous aspects of the BCBSNM rate calculation … Hence, the filing does not provide reasonable actuarial support for the proposed rate changes.”
Approving the rate hike would “continue a pattern of large rate increases for New Mexico health insurance consumers,” Schwartz cautioned, making it “increasingly difficult” for New Mexicans to afford individual health insurance.
The company presented numerous complex economic expense and loss indicators — variables such as “duration adjustments,” “deterioration adjustments,” and “annual deductible leverage.”
These figures were used to calculate an “Indicated Rate Change.”
Data presented contradicted BCBS claims
But the figures may have been smoke and mirrors, Schwartz suggested.
“The problem with the BCBSNM filing is that none of these various components … were documented or supported,” he said.
Where data was available, it contradicted Blue Cross Blue Shield’s claims, Schwartz found.
The “annual base trend” is an estimate of past financial losses. It is used to adjust projected future revenues from individual insurance policy premiums.
Schwartz calculated the company’s actual yearly loss trends on individual-market insurance policies over the past seven years and found they had varied between 4 and 8 percent — well below the 10 percent a year claimed by Blue Cross Blue Shield.
“Based upon this analysis, the loss values used in the BCBSNM rate filing are inflated and result in an excessive rate indication,” Schwartz said.
The Insurance Division and Attorney General’s office staff nevertheless negotiated a weekend rate settlement deal to raise Blue Cross Blue Shield rates by 21.3 percent for approximately 40,000 New Mexicans, without a public hearing that had been ordered by PRC commissioners. Former state insurance superintendent Morris “Mo” Chavez resigned in the face of outrage over the deal expressed by policyholders and PRC commissioners. Interim superintendent Tom Rushton, who helped negotiate the deal, subsequently resigned after PRC commissioners voted to direct him to vacate Chavez’s approval of the rate hike.
Parent company had surplus of $6.7 billion
Last month’s rate hike was just the latest of many, The Independent found. The Insurance Division had approved Blue Cross Blue Shield rate hikes every year since 2004, PRC documents show.
Blue Cross Blue Shield NM officials and former state insurance superintendent Morris “Mo” Chavez repeatedly raised the specter of the insurer’s solvency and financial losses. But asked about the financial condition of the insurer’s parent company, Health Care Service Corporation, Schwartz painted a very different picture, testifying the firm “has a strong financial position.”
“At year-end 2009, Health Care Services Corporation had a surplus of about $6.7 billion,” Schwartz testified, citing the corporation’s annual report.
In each year since 2004, the Insurance Division approved Blue Cross Blue Shield NM rate hikes. But for each year since 2005, Schwartz found, Health Care Service Corporation had a net income of at least $500 million, for a total net income of $4.4 billion.
Health Care Services Corporation’s net income last year exceeded $740 million, according to a May 25 online company profile.
Health Care Services Corporation’s annual report also showed “a much lower level of expenses” than Blue Cross Blue Shield NM claimed to the Insurance Division, Schwartz noted.
Blue Cross Blue Shield told state regulators that 26 percent of insurance premium revenues go to corporate expenses, but the parent company’s annual statement shows an 11 percent expense ratio, Schwartz said.
“While there may be an explanation for the dramatic difference in the expense ratios shown for Health Care Services Corporation as a whole and the values BCBSNM included in its filing, BCBSNM has not provided such an explanation,” Schwartz said.
Nor did the company include in their projected future losses, the savings resulting from disease prevention and wellness programs, Schwartz noted — even though those programs had explicitly been adopted to reduce policyholders’ medical claims costs.
Regulators did not request supporting documentation
Blue Cross Blue Shield did not provide supporting documentation for its claims because they were never asked to do so, according to company officials.
The Blue Cross Blue Shield rate increase filings included “everything required by the New Mexico Insurance Division,” Director of Actuarial and Underwriting Department Kevin Carr testified April 9, citing a Division checklist for rate increase filings. “We are not required by the NMID (Insurance Division) to include all of this documentation in our rate filing.”
“Based on my discussions and correspondence with the (Insurance Division) staff, they felt that our assumptions, including trend, were reasonable,” Carr testified.
Rate increase filings in New Mexico “generally do not include all of the underlying data”, Carr said. “In fact, based on my review of rate filings of other insurers in New Mexico, we generally provide much more information in our filings than most of the other insurers.”
Insurance Division staffers take insurers’ figures at face value, Carr’s testimony suggested.
For example, the 10 percent “annual base trend” figure Schwartz found to be inflated had been accepted by Insurance Division staffers even without the underlying data, Carr claimed.
“The 10 percent assumption for the annual base trend was specifically reviewed by and discussed with (Insurance Division) staff as part of the rate increase process, and they agreed that it was a reasonable assumption,” Carr said.
Insurance Division staff did not question the other figures, Carr said.
“The (regulatory) culture is insufficiently skeptical,” PRC Commissioner Jason Marks said. “On health care, the assumption is costs are just a national disaster and nothing can be done about it … that it’s unavoidable. But rates are rising faster than needed. There needs to be more skepticism, and related to that I’d like to see a different orientation. The regulator has a responsibility to make sure every penny passed on (to consumers) is required by law.”
Marks had described last month’s weekend rate hike settlement as “a back room deal,” a reference to the Insurance Division’s failure to hold public hearings.
The Division has a responsibility to confirm insurers have prudently incurred the expenses cited in rate change filings, Marks said.
“Just because there’s a cost in your accounting system doesn’t mean you accrued it responsibly and can pass it on to consumers,” Marks said.
New Mexico Public Regulation Commission (PRC) commissioners Thursday morning unanimously directed Interim Insurance Superintendent Thomas Rushton to rescind the Insurance Division’s controversial approval of a 21.3 percent hike in the health insurance rates for individual policyholders of Blue Cross Blue Shield N.M.
Rushton announced that he had recused himself from further involvement in the case.
That, at least, came as welcome news to the Attorney General’s office, according to Spokesman Phillip Sisneros.
“We do support Mr. Rushton’s recusal from a hearing on the matter,” Sisneros said. “(But) our position is still in support of the settlement. Remember, our agency is not the policy making authority on this issue and in fact, we were asked to step in to help find a resolution. We are happy to continue in that advisory role in the future.”
Rushton appeared reluctant to rescind the Insurance Division’s April approval of the rate hike, telling commissioners that rate change review procedures had been followed.
“There was a hearing conducted,” Rushton said. “There was prefiled testimony. There was discovery. There was a settlement reached, and Morris Chavez accepted that stipulated settlement.”
PRC Chairman David King interrupted Rushton to say that there were outside interests that had not been heard in the rate hike settlement process.
“We’ve had death threats to the Commission, to staff, and the former superintendent (Chavez),” King said. “They certainly followed the law, but it wasn’t done as well as in California,” where a Blue Cross rate hike was recently overturned.
Rushton assigned Deputy Insurance Superintendent Darlene Gomez to be the hearing officer for the reconsideration of the settlement approval. Gomez will receive whatever staffing assistance she needs from the Commission, King pledged.
But the Insurance Division will work under close Commission scrutiny, King said. King said the Commission will also ask for a third-party independent audit of Blue Cross Blue Shield NM’s financial records.
Commissioners King, Jason Marks, and Jerome Block, Jr. have all said they want the PRC to investigate why Blue Cross Blue Shield has a virtual monopoly in much of rural New Mexico.
Marks and Block appeared to try to manage policyholders’ expectations, Thursday.
“I don’t want false hope here,” Marks said. “It’s only right to do what we can. But we don’t want false hope. There’s still a stipulated settlement.”
Block said Blue Cross Blue Shield was starting “from scratch,” as far as he was concerned.
But he cautioned that the company would not take the Commission’s decision lightly, and warned policyholders that the extra scrutiny could backfire on consumers.
“They’re going to come out swinging,” Block said. “There could be (financial) data that justifies a higher increase. I hope the public is ready to face that outcome if it’s substantially different.”
Switching interim superintendents?
Marks also floated the possibility of replacing Rushton as interim superintendent with former insurance superintendent Don Letherer, noting that Rushton is very busy.
“Don could keep the wheels on,” Marks said. “We’d have twice the assurance the job’s getting done.”
Commissioners agreed to add a meeting with Letherer to next week’s Commission agenda.
Interim state Insurance Superintendent Tom Rushton may rescind his predecessor’s April 26 approval of a Blue Cross Blue Shield New Mexico health insurance rate hike — the result of a weekend settlement Rushton helped negotiate to the outrage of policyholders and Public Regulation Commission (PRC) commissioners. Commissioners want Rushton to stand aside while the rate increase is re-examined, and Commission chairman David King is calling for a third-party audit of the insurer’s books.
