Medical Loss Ratio Debate Rages

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 HCAN’s Executive Director Ethan Rome, describes a report issued by HCAN, Sen. Al Franken (D-Minn.) and Rep. Bill Pascrell Jr. (D-N.J.) along with members of the Main Street Alliance, a network of state-based small businesses that “shines a light on the accounting tricks the insurance companies want to play to game the medical-loss ratio system, and it exposes their lobbying offensive to protect the status quo and undermine this part of the law before it even takes effect.”