He sure does his dangedest to invite it.
Perry, a Republican, has vowed not to expand Medicaid and not to create an insurance exchange. Consumer advocates in Texas say the Perry administration has also been dragging its feet when it comes to insurance rate review.
To make insurance more affordable, the federal law requires every state to conduct a special review whenever a health insurer wants to raise premiums more than 10 percent. This rate review would help protect small businesses and individuals who buy their own policies. The provision went into effect last September, and since then, insurers made nine such requests in Texas.
But so far the Texas Department of Insurance hasn’t completed any reviews. Officially, they’re all pending.
In the meantime, the insurance companies can go ahead and raise the rates anyway. An insurer called Celtic, for example, has raised rates on three policies in Texas by 20 percent.
“We were growing increasingly frustrated,” said Mimi Garcia, organizing director for Texas Well and Healthy, an advocacy group that has been active on the rate review issue.
“They’ve been very unresponsive,” Garcia said of the Department of Insurance. “They have not returned calls. They have not returned repeated requests. And it really took having over 1,600 Texans signing on to a petition to say, ‘Hey, this is something we care about and we need to know what’s going on with this.’ ”
What does that mean? TPM will tell you what that means:
To protect consumers, the Affordable Care Act requires states to review insurance rate hikes above 10 percent and, if deemed unreasonable, compel the companies to justify them. Since the provision took effect last September, insurers have made 9 requests, NPR reports, and nearly a year later Texas hasn’t reviewed a single one, even though it accepted a $1 million federal grant for rate review. Meanwhile, state insurers are freely raising their rates, including one company that jacked rates by about 20 percent.
The law gives states the first pass at rate review. But if they are deemed by the administration not to have “an effective and timely” process, the federal government takes over. At this point, Texas is goading the Obama administration to move in that direction.
“Under the circumstances it seems like HHS needs to reevaluate whether Texas meets these criteria,” said Tim Jost, a professor of health law at Washington and Lee University.
As the government’s Affordable Care Act website explains, “If your state doesn’t have a Rate Review program, or has a Rate Review program that is ineffective, the federal government will conduct Rate Reviews in your state.”
Maybe Perry is just biding his time, as the TPM story suggests; perhaps he’s looking for some legal pretext to get Greg Abbott to file another lawsuit, or maybe he’s just waiting to see if the feds will blink. Maybe he relishes another confrontation for all the fundraising and base-whipping it allows him to do. Maybe he just hasn’t thought it all through, or has been too busy with other things to make this a priority. Any of these explanations are plausible, and there are likely others I’m not thinking of. But it sure is a weird dynamic, defying the feds by forcing them to step in.