The department released data about the insurers’ rate requests on Friday, saying the increases would have been more than double the hikes requested if the Democratic-controlled Legislature and Gov. Phil Murphy did not act to create the state’s own so-called “individual mandate” requiring most residents to obtain insurance coverage or pay a fine.
TRENTON — Insurance companies are seeking state approval to increase the prices for their individual market policies on average near 6 percent for the upcoming year, according to the state Department of Banking and Insurance.
The department released data about the insurers’ rate requests on Friday, saying the 5.8 percent average increase would have been more than double the hikes requested if the Democratic-controlled Legislature and Gov. Phil Murphy did not act to create the state’s own so-called “individual mandate” requiring most residents to obtain insurance coverage or pay a fine.
The federal government’s insurance mandate was essentially eliminated by the Republican tax overhaul President Donald Trump signed in December, which reduced the tax penalty residents who failed to obtain health coverage were forced to pay to zero.
In response, Murphy signed legislation co-sponsored by Sen. Troy Singleton, D-7th of Palmyra, and Assembly members Herb Conaway, D-7th of Delran; Carol Murphy, D-7th of Mount Laurel; and Pam Lampitt, D-6th of Cherry Hill, in May to create an almost identical insurance mandate and penalty.
Without the state’s action, insurers would have asked for an average increase of 12.6 percent, according to DOBI.
“New Jersey is working aggressively to ensure that residents have access to affordable quality coverage, and actions taken by the state to improve the market are reflected in the rates submitted, DOBI Commissioner Marlene Caride said in a statement. “Carriers were clear that without state action, the average increase requested in the individual market would have more than doubled.”
The individual rate proposals are being reviewed by the department to ensure they are justified and comply with state and federal laws, Caride said.
Horizon Blue Cross Blue Shield of New Jersey, which is the state’s largest health insurer, is asking for a 9.2 percent average increase for its exclusive provider plans and a 0.3 percent average increase for its HMO plans.
AmeriHealth is seeking on average a 0.8 percent increase for its exclusive provider plans and a 1.4 percent increase for its HMOs.
Had the individual mandate not been created, Horizon reported it would have requested a 15.4 percent increase on its exclusive provider plan and a 6.2 percent on its HMO plans. AmeriHealth reported it would have sought increases on average of 8.8 percent for its EPO plans and 9.4 percent hike for its HMO plans, officials said.
The other two insurers selling on New Jersey’s individual market are Oscar and Oxford. Neither offer HMO plans and are seeking on average a 6.2 percent hike and 1.8 percent hike on their respective exclusive provider plans.
In addition to creating an individual marketplace, Murphy signed companion legislation to seek federal approval to create a reinsurance program that would help insurers in the state cover high-risk residents and their costliest claims.
At least half of the projected $280 million cost for the reinsurance program is expected to be paid by the federal government and the law requires the administration to seek a waiver from the federal government to implement the program. Another $100 million is expected to come from revenues generated from the new penalty on residents who fail to obtain adequate health coverage.
The department is still awaiting federal approval for its reinsurance program. If approved, the program is expected to reduce the price of plans on the individual market by 15 percent, state officials said Friday.
The individual plans are sold on the federal marketplace created by the Affordable Care Act.
About 275,000 New Jerseyans obtained coverage through the ACA’s exchange this year, down from 295,000 who signed up for coverage last year.
During a Monday morning news conference, Democratic lawmakers and health care advocates blamed the decrease on the Trump administration, arguing that the Republican president has sought to sabotage the Affordable Care Act by reducing funding for outreach and signup assistance, as well as the elimination of the individual mandate and the president’s refusal to provide funding for cost-sharing subsidies reimbursing insurers for mandated reductions in copays and deductibles for certain low- and moderate-income residents.
More recently, the administration has frozen payments to the ACA’s “risk adjustment” program, which provides billions in payments to insurers with high-risk patients.
Democrats and advocates have warned that those actions would prompt insurers to increase their prices or leave the individual markets in some states entirely.