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The Affordable Care Act gives states some latitude in how they implement parts of the law. And some states have been more enthusiastic than others about setting those provisions in motion. In Texas, consumer advocates say the state is lagging behind on a key consumer protection required by the law and they're frustrated by the delay, as we hear from Carrie Feibel of member station KUHF in Houston.

CARRIE FEIBEL, BYLINE: In an effort to make insurance affordable, the federal law requires states to conduct a special review whenever a health insurer wants to raise premiums more than 10 percent. This rate review would help protect small businesses and individuals who buy their own policies. Mimi Garcia is the organizing director for Texas Well and Healthy, an advocacy group. She and other consumer advocates say Texas regulators have been dragging their feet.

MIMI GARCIA: We were growing increasingly frustrate that there seemed to be no response. Not even we're working on it or we're getting there. But for a long time just nothing, no returned calls or any of that.

FEIBEL: Rate review became mandatory last September. Since then there have been nine requests by insurance companies in Texas to raise rates above 10 percent. Regulators are supposed to review each request and say if it's OK or unreasonable. But so far, the Texas Department of Insurance has not completed any reviews. Officially, they're all pending. Texas Well and Healthy started a petition to push regulators to act.

Anne Walker signed it, along with 1,600 other Texans. Walker is the director of financial aid at Rice University in Houston.

ANNE WALKER: I'm not sure why the state has let some of its citizenry down by not monitoring it. It's the law, and Rick Perry is choosing to ignore it.

FEIBEL: In the meantime, the insurance companies can go ahead and raise the rates anyway and some already have. The Texas Department of Insurance got a $1 million grant from the federal government to hire outside auditors and start conducting the rate reviews. A department spokesman, John Greeley, did not answer specific questions, though he did say the department is working on various aspects of the federal health care law.

Alexis Ahlstrom works on insurance oversight for the federal government. She says Texans may need to be a little more patient.

ALEXIS AHLSTROM: You want the Department of Insurance to being doing a thorough review and that sometimes can take time. They might go back to the issuer and ask for more information, they may be working with the issuer to lower a proposed increase. So the end result might be very positive for Texas consumers when the Department of Insurance does make these determinations.

FEIBEL: Even if the department does determine that a premium hike is unreasonable, it can't actually do anything to stop it. But Garcia says at least there would be more transparency for people who have to shop for their own insurance.

GARCIA: They can say: Wow, that's a lot more money every month and apparently it's completely unjustified. I'm going to go shopping somewhere else.

FEIBEL: Advocates want those results published now, so they can start working on their next priority - changing state law so that insurance regulators can actually overturn what they consider to be an unreasonable rate hike. In Texas, regulators can do that for auto and home insurance, but not health insurance.

For NPR News, I'm Carrie Feibel in Houston.


CORNISH: This story is part of a partnership with NPR member station KUHF and Kaiser Health News.




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