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Oregon Insurers Seek Steep Rate Hikes From Individuals

Proposals submitted this week would have rates climb as much as 20.7 percent on the individual marketplace, with nearly all silver-level plans now costing over $400 per month. Small businesses face smaller increases of 2 percent to 8.5 percent, with most small group plans still below $400 per member per month.
May 17, 2017

Uncertainty in the insurance industry is again pushing up the cost of health coverage for individuals and small businesses, according to rate requests submitted to the Oregon Department of Consumer and Business Services this week. And in some areas of Oregon, people buying individual health insurance will have only one choice, Providence Health, if they hope to shop for coverage on the state’s marketplace.

In the individual market, eight companies submitted average rate change requests ranging from a 6.9 percent to a 21.8 percent increase. In the small group market, 10 companies submitted average rate requests ranging from a 2 percent to an 8.5 percent increase.

The rate filings drew criticism from U.S. Senator Ron Wyden, D-Ore., who pinned particularly steep individual insurance market increases on federal-level political machinations.

“Today’s news reflects the Trump administration’s continued efforts to sow chaos about the future of individual markets around the country with overt threats of sabotage,” Wyden said in a statement released Tuesday. “The Trump administration and Republicans in Congress should quit playing games with the future of Oregonians’ healthcare and work with me and other Democrats on lasting improvements to our healthcare system.”

Under the rate proposals submitted by the insurance companies, here’s what 40-year-old individual purchasing silver-rated coverage in the Portland area would pay each month, ranked from most to least expensive Affordable Care Act compliant plan:

  • BridgeSpan Health Company: $472, up 17.2 percent
  • PacificSource Health Plans: $470, up 6.9 percent
  • Regence BlueCross BlueShield of Oregon: $468, up 18.7 percent.
  • Health Net Health Plan of Oregon: $440, up 12.5 percent
  • Moda Health Plan: $436, up 13.1 percent
  • Providence Health Plan: $414, up 20.7 percent.
  • Kaiser Permanente: $348, up 12.4 percent.

ATRIO Health Plans, not included in this ranking because it does not operate in the Portland area, would cost a comparable individual even more under its proposed 21.8 percent rate hike – with silver-rated coverage costing $477 per month for a 40-year-old in the Bend area.

The rate requests reveal drastic shifts within the individual insurance market. When ACA rates first debuted several years ago, Kaiser was among the more costly insurers in the state, while Moda’s rates were among the lowest.

Small employers would see much more modest rate hikes under the proposals submitted to state regulators. Ranked from most to least expensive, here’s what a small group plan would pay each month to provide a 40-year-old Portland-area employee with silver-level coverage:

  • Moda HealthPlan: $415, up 2.8 percent.
  • Health Net Health Plan of Oregon: $389, up 2 percent.
  • PacificSource Health Plans: $370, up 8.5 percent
  • Providence Health Plan: $338, up 8.5 percent.
  • Samaritan Health Plans: $336, up 2.7 percent.
  • United HealthCare: $331, up between 3 percent and 5.6 percent, depending on whichdivision of the company issued the plan.
  • Regence BlueCross BlueShield of Oregon: $322, up 6.6 percent.
  • Kaiser Permanente: $289, up 2.8 percent.

ATRIO Health Plans, not offered in the Portland area, would cost a comparable employer in the Bend area $376 per month to cover a 40-year-old employee, a 3.9 percent rate hike.

"We know there are still many unknowns facing insurers and consumers as we look ahead to 2018," Insurance Commissioner Cali Robison said in a statement. "Now that the filings are in, we will begin our vigorous review to ensure the proposed rate changes, including the potential impact of various sources of uncertainty, are actuarially sound and justified."

Insurance companies are required to file rates based on the assumption that cost-sharing subsidies will be continue under the Affordable Care Act in 2018 – an assumption that could prove incorrect depending on federal-level legislation. If Republicans push through an overhaul or replacement of the ACA, these proposals could prove moot.

This year's rate requests follow two years of even steeper rate increases. Rates increased an average of 23 percent in 2016 and 27 percent in 2017. Medical claims for Oregonians have been higher than expected, and federal programs aimed at limiting risk for insurers have ended, according to regulators. Many health insurers have also chosen to shrink their presence in some areas of the state.

In Lane, Lincoln and Tillamook counties, Providence is the only insurer offering health coverage on the ACA marketplace – a situation Department of Consumer and Business Services Director Patric Allen foresaw.

"We continue to be concerned about the level of choice for Oregonians across the state," Allen said.

He has previously spoken of the possibility that some rural Oregon communities could find themselves with single-payer healthcare by default if too many plans exist the market.

"In the coming weeks, we will be exploring our options to ensure all Oregonians have access to plans that fit their needs."

Legally, the rates proposed by insurers are required to reflect the average cost of providing healthcare to a member in Oregon's health insurance market.

The state estimates that the average cost of paying claims in the individual health insurance market in 2016 was $384 per member per month; in 2015, the average cost of paying claims was $385 per

member per month. Health insurance companies are required to justify any differences to this average in their rate filings.

The proposals submitted by insurers this week will be reviewed and may be tweaked or rejected by Oregon insurance regulators, who say they will post rate filings and begin accepting public comments by Monday, May 22. A special-purpose website,, will carry details about public hearings on the rate hikes, and will accept comments through mid-July.

Although public comments will be taken until July 11, the Department of Consumer and Business Services estimates it will announce its preliminary rulings on rate requests sooner than that, on June 29.

Reach Courtney Sherwood at [email protected].