Cross-Cutting Issues: Monitoring State Implementation of the Affordable Care Act in 10 States: Rate Review

With support from the Robert Wood Johnson Foundation (RWJF), the Urban Institute and Georgetown University's Center on Health Insurance Reforms are undertaking a comprehensive monitoring and tracking project to examine the implementation and effects of the Patient Protection and Affordable Care Act (ACA) of 2010. The project began in May 2011 and will take place over several years. The Urban Institute will document changes to the implementation of national health reform in Alabama, Colorado, Maryland, Michigan, Minnesota, New Mexico, New York, Oregon, Rhode Island and Virginia to help states, researchers and policymakers learn from the process as it unfolds. This report is one of a series of papers focusing on particular implementation issues in these case study states. In addition, state-specific reports on case study states can be found on the Robert Wood Johnson Foundation and Health Policy Center websites. The quantitative component of the project is producing analyses of the effects of the ACA on coverage, health expenditures, affordability, access and premiums in the states and nationally. For more information about the Robert Wood Johnson Foundation’s work on coverage, visit their website. This paper describes the status of rate review programs in the 10 states participating in the Robert Wood Johnson Foundation’s monitoring and tracking project. Information is drawn from publicly available sources, state legislation, and site visit interviews in each of the 10 states. We summarize how the 10 case study states have enhanced their rate review authority and processes, increased transparency, and expanded consumer outreach in response to the ACA. Although there has been significant variation, all 10 states took some action to improve their rate review process and ensure that insurers’ proposed rates are justified. To a large extent, the actions taken by these states reflect the diversity of approaches to rate review that exist among states nationwide.