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President Barack Obama and HHS Secretary Kathleen Sebelius, whose department implemented the Affordable Care Act.

(AP file)

WASHINGTON, D.C. -- Affordable Care Act premiums for Ohio's biggest and most popular health insurers will rise on average by only single digits in 2015 if Ohio insurance regulators approve them, according to newly filed rate requests and Plain Dealer interviews with insurers.

While almost no one is pleased with price hikes, these would be relatively moderate when compared with double-digit premium hikes in years before the act took effect.

This runs counter to an announcement Thursday by Lt. Gov. Mary Taylor that individual rates would go up by 13 percent on average and small-group business rates by 11 percent.

Taylor, a Republican who also heads the Ohio Department of Insurance, said that "Obamacare is hitting us harder and driving our costs up significantly."

But Taylor's analysis was based on a simple calculation that used the requested hikes from every insurer participating in the Affordable Care Act, or ACA, Ohio market. The formula lumped in rate requests for insurance companies with only a small market share -- and those only now entering Ohio's ACA market -- with the giants such as Medical Mutual and Anthem Blue Cross and Blue Shield.

The latter companies have many more customers, and their premium requests are lower.

The Ohio Department of Insurance said it had to use a simple average because it would have been difficult to give a weight to companies that are new to the ACA and have no market share.

Medical Mutual of Ohio, which had double-figure hikes before the ACA, has requested an average premium increase of 7.73 percent over 2014, according to state records.

Anthem has requested hikes that average 8.9 percent, according to its filings.

HealthSpan, which last year acquired Kaiser Permanente in Northeast Ohio, has requested a 7 percent increase in 2015 in the Cleveland market, according to spokesman Chuck Heald.

In a development that could shake up the Cleveland-area market, Aetna, a major national insurer that largely stayed on the ACA sidelines in Ohio this year, will sell individual policies on the exchange in the state for 2015, according to its filing and a Plain Dealer interview. And Aetna says it will cut prices.

Aetna only sold policies in rural areas this year through a smaller company it acquired, Coventry Health Care. Aetna filed initially to sell its own policies on the ACA exchange in 2014 but then withdrew, saying it wanted to enter the ACA marketplace cautiously.

But "Aetna is going to be on the exchange next year" in Ohio, said spokesman Rohan Hutchings. While some insurers only cover part of the state, Aetna plans to enter the Cleveland metro market with policies on the ACA exchange, Hutchings said.

When compared with the premiums that some Ohioans paid for individual Aetna policies off the exchange, Aetna projects its ACA premiums in Ohio will result in a 7.5 percent decrease.

"This is all about serving more Ohioans with affordable products that are simple to understand and deliver value," Hutchings said.

Premium prices are based on the ages of those expected to buy and on insurers' expectations of the health care costs the enrollees will incur. It is too early to know how that will work out in 2014, yet the state statutory deadline for initial 2015 rate filings was last week. "So all they have now are trends and guesses," said J.B. Silvers, a health-care finance professor at Case Western Reserve University.

Still, Ohio insurers know something about the clients they have already enrolled, including the fact that they are slightly older than the national average. That would normally portend higher medical costs.

Yet as 2014 open enrollment, which started last fall, continued until April, "enrollment got younger and younger," said Heather Thiltgen, Medical Mutual's vice president of individual sales and marketing. "And we expect that to continue and to keep our rates in the single digits."

Actual monthly premiums could vary widely, despite the averages. According to a Department of Insurance rate sheet provided to The Plain Dealer, average requested sums for 2015 include $360 (InHealth), $363 (Summa), $449 (Anthem), $396 (Medical Mutual) and $373 (Aetna).

But one new entrant to the ACA market, Assurant (also known as Time Insurance Company), has proposed average premiums of $528, according to the state. That figure alone helped push the entire statewide average higher.

An Assurant spokeswoman said the company, which already sells policies off the exchange, is still deciding which markets it will enter.

Every price in the filings comes with caveats. The Ohio Department of Insurance must approve the requested rates, and that will not happen for several months. The U.S. Department of Health and Human Services must then sign off, although it typically will agree with Ohio's judgment since the state must follow ACA rules and guidelines for insurance underwriting and pricing.

Also, every insurer provides an average, but the averages are based on both higher and lower premiums for specific policies. For example, Anthem's average 8.9 percent price hike is based on individual policy hikes that reach a high of 13.6 percent -- for a bronze-level plan with a $4,300 deductible -- and a low of 2.1 percent for a catastrophic plan that offers little coverage, according to its filing.

Anthem has a range of other increases, with a number around 7 percent or lower for bronze and silver plans. These are weighted averages and could be higher or lower depending on an individual's age.

Many consumers will get federal tax subsidies to offset their premium costs.

Health policy analysts, journalists, and ACA critics and proponents are only now beginning to wade through the new Ohio filings, which were submitted on or before May 23. The Plain Dealer asked the state twice over the last week for information about the filings and received it Thursday evening.

Kathleen Gmeiner of the Universal Health Care Action Network of Ohio, a pro-ACA group, said she had not had a chance to look through the filings but sees the 13 percent average used by Taylor as problematic because some companies' rates will be smaller. Annual premium hikes before the ACA were frequently high, she added.

"It's up to the insurance commissioner and her staff to go through the rate increase proposals and see if they are justified," Gmeiner said.

The ACA required most Americans to have health coverage in 2014 or face federal fines. It limited the range of premiums an insurer could charge based on a customer's age, and banned screening out clients if they had preexisting medical conditions. It set a baseline of essential benefits that must be covered, including maternity care preventive medical care.

It also required insurers to spend most of their premiums on health services rather than marketing and profits. And it established computerized marketplaces, known as exchanges, for individuals to shop for their policies.

The law, passed in 2010 and still being phased in, is a flash point for disagreement between Democrats and Republicans. Democrats controlled both houses of Congress and the White House when the ACA passed, and they said an advanced society like the United States could afford, like other countries, to provide health coverage to its citizens.

Republicans, including Ohio's Taylor, said it interfered with free markets and removed consumer choice by requiring essential coverage even though an individual might prefer a bare-bones policy. Many Republicans object to using tax money, including new taxes on medical devices and insurance policies, to subsidize others' insurance purchases. But Democrats still control the Senate and White House, and repeated House of Representatives efforts to repeal the ACA simply stall after the House passes them.

When releasing the averages Thursday, Taylor said in a statement, "Higher premiums will continue to put a strain on consumers and small businesses at a time when our state's economy is showing strong signs of recovery and growth. Continued and unnecessary headwinds out of Washington are making it more difficult for job creators, hard-working Ohioans and their families to purchase health insurance."

The Obama administration issued a statement in response, saying, "Before the Affordable Care Act, consumers in individual market regularly faced annual double-digit premium increases. This is just the beginning of the process and as we saw last year all across the country, proposed rates were a high water mark and final rates were often lower than initially proposed. We are very pleased to see that the number of issuers planning to offer Marketplace plans in Ohio has jumped by 25 percent."