State Efforts to Increase the Availability and Affordability of Health Insurance: Hearing Before the Subcommittee on Antitrust, Impact of Deregulation, and Privatization of the Committee on Small Business, House of Representatives, One Hundred First Congress, Second Session, Tulsa, OK, August 10, 1990, Volume 4

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Page 82 - Currently, in order to protect themselves against adverse selection,3 insurers medically underwrite small groups before accepting them. Groups that have sick or disabled employees or dependents often find it extremely difficult, or impossible, to get health insurance. Sometimes these groups deliberately exclude the sick individual from the group plan in order to obtain coverage for the remainder of the group. In addition, some insurers refuse to write coverage for groups in certain professions or...
Page 66 - Vacancies occurring in the office of a commissioner from any reason or cause shall be filled for the unexpired term in the same manner as for a full term appointment.
Page 168 - This will allow us to assure that high risks are spread, broadly through the private market rather than concentrated in one small employer group. The reinsurance mechanism naturally would sustain financial losses or shortfalls, since carriers would reinsure only persons whose claims are expected to exceed the price of reinsurance. The intent of the proposal is that losses be financed privately. Losses first would be spread across carriers in the small employer market...
Page 76 - However, if the insurer builds-in rate increases for all groups, the healthier groups (who can pass medical underwriting with another insurer) will move to another insurer to keep a low initial rate. In response, insurers have developed "tier rating". In tier rating, the claims experience of a group is used to select its premium level at renewal. Insurers increase rates more for groups with poor claims experience (eg, high claims...
Page 67 - Women, or so many of them as shall accept such office, each of whom shall serve without compensation, but shall be reimbursed for expenses incurred in the performance of official duties...
Page 83 - The goal is to assure that individuals and groups are not denied needed coverage because of health problems. However, as we noted above, efforts such as these to guarantee availability of coverage will not lower the ultimate cost of health care coverage. Indeed, by providing access to higher risk groups and spreading the costs throughout the marketplace, health insurance premiums may increase (the increase should be slight) . Again, the critical problem of affordability must be addressed by a broader...
Page 164 - President, Health Insurance Association of America. HIAA is a trade association of 320 private health insurance companies which provide health insurance for 95 Million Americans. Mr. Chairman, the escalating spiral of health care costs continues to plague our society. The re-bors of this committee have seen in exquisite detail its effects on the Medicare program.
Page 76 - Low initial rates are possible because insurers medically underwrite (use health screening) to assure that the group is healthy before they accept it for coverage. A healthy group will generally produce lower than average claims experience, so the insurer can charge lower rates initially. However, the benefit...
Page 169 - ... assure that no small employer, and no employee of a small employer, will be turned down for health insurance because of poor health. They will restore the concept of pooling risk across large groups, greatly limiting how much of the cost of poor health must be borne by the individual employer. Further they will moderate significantly the sometimes dramatic premium increases now experienced by small employers at renewal time and thereby reduce the incentive to change carriers frequently. With...
Page 80 - Otherwise, the annual rate change is based primarily on the change in rate for new business — which should reflect the trend in health care costs and utilization. The new business rate was chosen as an index because insurers are heavily penalized if they cheat: if they raise it too much they would be uncompetitive for new business; if they keep it too low, they would be underpricing the entire class and incur significant losses. The overall rate bands in this Arkansas...

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