Former HHS Official Files Lawsuit, Claims ACA Violations
By - The Affordable Care Act’s (ACA) rate-review provision states that insurers must submit proposed premium rate increases of 10 percent or more to federal authorities. Additionally, insurers need to justify their reasoning for the increases. However, a recent lawsuit filed by a former Department of Health and Human Services (HHS) employee states that the federal organization is improperly hiding health insurers’ requested rate increases from the public.
Jay Angoff used to oversee ACA implementation for HHS, and in the lawsuit, Angoff claims that HHS hasn’t lived up to its obligation to make the rate filings available before they take effect. This is important so the public can comment on them if necessary, Angoff said.
“Allowing the public to see not just the rate itself but the justification, the assumption companies make on which the rate is based, is something that can only have a pro-competitive effect in the market,” Angoff told the Washington Post. “The only way those rates are likely to come down is if the rate filing justifications are made public.”
Most states conduct their own reviews of insurers’ proposed rate increases. However, HHS reviews proposed rate increases for states that do not have effective rate review programs.
The lawsuit was filed on behalf of a Missouri consumer advocacy group. On Aug. 20, the group sent HHS a Freedom of Information Act (FOIA) request to disclose the rate filings – a request that did not receive a response, according to the lawsuit. Moreover, HHS reportedly ignored a plea from dozens of national and state consumer organizations to make the rate filing information public. According to the lawsuit, HHS simply thanked the organizations for “recognizing the importance of making public the rate filing information,” but did not actually grant the request.
“Missouri does not require insurers to file any documentation with the state or make any information available to the public regarding proposed rates,” Angoff explained in the lawsuit. “Therefore, Missouri citizens are entirely dependent on HHS for information regarding the identities of issuers filing rates in Missouri, the rates they seek to charge, and the justification for those rates.”
Additionally, Angoff’s lawsuit said there is no legal basis for HHS to not disclose the financial records being sought, and the information cannot “be withheld under any FOIA exemptions.”
HHS spokesman Ben Wakana told the news source that the organization is “readying the rate change information.”
“The Department is committed to providing consumers accurate information so they can make informed decisions, and therefore, before the beginning of Open Enrollment, the agency will publish final insurance rates for all 50 states,” Wakana said in an email.
This is not the only recent example of healthcare issues being brought before a judge. Earlier this month, the US Supreme Court announced that it would decide on a case concerning Medicaid reimbursement rates. The Court will rule whether private medical providers can sue a state to raise Medicaid reimbursement rates to deal with rising medical costs. In December 2013, the 9th U.S. Circuit Court of Appeals said the providers could sue and ruled in their favor on the merits. However, Idaho appealed the ruling and the justices agreed to hear the case.
