Discussion about the portion of the health care reform law that requires health insures to maintain a medical loss ratio (MLR) of 80% for individual and small-group products (and 85% for large) is heating up, as critics ratchet up their rhetoric. The debate centers on how insurers may already be responding to the law’s mandate, effective January 1, which require insurers not meeting the MLR minimums to rebate their customers.
The political watchdog group Health Care for America Now has been particularly vocal. A blog written by
The rules regarding exactly how MLR will be calculated have not yet been released, however, and will be published after the administration receives recommendations from industry associations, The
Ahead of this recommendation, notes the HCAN blog, Sen. John D. Rockefeller (D-W.Va.) reportedly has sent a
According to
Adding further fuel to the controversy is the possible restructuring of how insurers pay brokers and agents. “Some health plans are beginning to restructure the way they pay their brokers and agents in an effort to reduce the percentage of premium dollars that go toward commissions,” AIS Health.com reports.
“They [insurers] want to continue their long-time practice of spending low percentages of premium revenue on actual medical care in certain states and for certain customers,” notes Rome in his HCAN blog.
Even the term “medical care” is fodder for debate. “They want to change the definition of "medical care" to include things that aren't medical care and that have never been considered as such,” notes Rome in his blog. “And the insurance companies are shameless in just how far they will go. They really are trying to have "underwriting," the process by which sick people are weeded out of eligibility for coverage, defined as a medical expense! Along with claims processing, call centers and other expenses that aren't about the actual delivery of care.”
In response, America's Health Insurance Plans’ spokesman Robert Zirkelbach told INN that, “This is a desperate attempt to distract attention away from the fact that these regulations could put at risk important services and benefits that improve the quality of care for millions of patients.”