UnitedHealth Group Inc., the largest U.S. health insurer, said its rates for Obamacare plans in New York may be too low because the failure of a competing insurer last year might lead to shortfalls in payments designed to stabilize Obamacare markets.
In states like New York, health insurers participating in the Patient Protection and Affordable Care Act negotiate annually with regulators to set prices for coverage. UnitedHealth’s rates were set anticipating risk-sharing payments designed to stabilize the new insurance markets, William Golden, the company’s northeast region chief executive officer, said Wednesday at a state Senate round table in Albany. If the loss of a participant reduces the funds available to UnitedHealth, the company’s rates in New York’s Obamacare market may be insufficient, Golden said.
“I have rates that are substantially too low based on risk-adjustment payments not being paid,” he said in the meeting.
Others in the state’s health insurance industry criticized the Department of Financial Services’ rate-review process as well. Paul Macielak, who runs the New York Health Plan Association, said DFS let Health Republic charge too little for its plans.
“Prior approval is a failed state policy,” Macielak said. “As it currently exists, it provides the superintendent with unfettered discretion to set rates.”
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Jeffrey R. Ungvary President