January 30th, 2012HHS tells Texas it can’t phase in health reform’s medical loss ratio
The Obama Administration rejected Texas request that it be allowed to phase in federal health reforms medical loss ratio to prevent the states health insurance market from destabilizing.
The U.S. Department of Health and Human Services ruled that state officials failed to convince the agency of its argument that if insurers had to meet the new requirements the number of companies providing health insurance in the state through employers would drop.
A total of 17 states have sought waivers from the MLR provision. Six received them, nine were denied and two more are pending.
The Patient Protection and Affordable Care Act, passed in March 2010, requires health insurers to spend no more than 20% of individual and small-group premiums and 15% of large-group premiums on administrative costs, including agent commissions. The remainder must be used for medical costs, as President Barack Obama and the Democratic-controlled Congress sought to ensure that health insurance companies and their executives were not taking too much of premiums for profits.
Insurance companies who exceed the medical loss ratio must pay rebates to their customers, starting Aug. 1.
The Texas Department of Insurance had asked for the law to be phased in over four years to ensure that small carriers and those writing individual policies dont leave the states insurance market.