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Insurers to Raise ACA Rates

With the results sure to affect politics as well as pocketbooks, health insurers are preparing to raise rates next year for plans issued under the Affordable Care Act.

But how much depends on their ability to predict how newly enrolled customers — for whom little is known regarding health status and medical needs — will affect 2015 costs.

“We’re working with about a third of the information that we usually have,” said Brian Lobley, senior vice president of marketing and consumer business at Pennsylvania’s Independence Blue Cross. “We’ve really been combing the data to get a first look.”

At stake are price increases that buyers on the federal exchange, HealthCare.gov, and other online marketplaces will encounter when they get renewal notices this year. Forecasting success or failure could also affect whether insurers stay on the exchanges, a key pillar of the health overhaul.

The 2014 enrollment period closed at the end of March for most consumers. But carriers selling medical plans on HealthCare.gov must file initial 2015 rate requests with federal regulators in late May or June, even though they have little idea about the health and potential costs of their newly enrolled members. Deadlines also loom for state-run exchange filings.

WellPoint, the biggest player in the online exchanges, is talking about double-digit rate hikes for 2015. Such increases would give ammunition to Republican critics before the November elections.

Analysts’ expectations vary, but nobody is predicting decreases.

“We’ll see rate increases in the marketplaces, but I think it’s anyone’s guess” about what the precise changes will be, said Sabrina Corlette, project director at the Georgetown University Center on Health Insurance Reforms. “It’s like nailing Jell-O to a wall.”

The health law required insurers to accept all applicants this year for the first time without asking about existing illness. That reduces what they know about customers and raises the likelihood that they’ll sign sicker, more expensive members who were previously denied coverage.

At CoOportunity Health, a nonprofit carrier in Iowa and Nebraska, many enrollees scheduled medical treatments — including surgeries — as soon as possible after their coverage began Jan. 1, said chief operating officer Cliff Gold. Among the procedures were several expensive transplant operations, including heart and lung procedures that can cost more than $1 million each.

But insurers tend to receive pharmaceutical claims long before hospital bills. They are poring over these early prescription records for clues about new members’ medical status.