"Amorphous Displeasure" - MLR Confusion Lends Glimmer of Hope

jbage007

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Seems like some carriers are threatening to leave the market place instead of lose money. I'm telling ya - this approach WILL work especially if more and more carriers have the balls to play chicken with the feds!

From the article:
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The Affordable Care Act calls for the NAIC to help implement new minimum medical loss ratio (MLR) provisions, which will require large plans to spend at least 85% of revenue on health care and quality improvement activities, and individual and small group plans and insurers to spend at least 80% of revenue on health care and quality improvement efforts.

Most of the minimum MLR provisions are set to take effect on or after Jan. 1, 2014.

Implementing the minimum MLR requirement is proving to be the most challenging PPACA issue the NAIC has taken up thus far, officials said.

State regulators want to write regulations that are narrow enough to conform with the law but broad enough to avoid forcing insurers out and disrupting the health insurance market.

Meanwhile, many companies are saying they will have to drop out of the individual health insurance market because they cannot meet the 80% MLR requirement.

Iowa and Maine already are looking to HHS for a minimum MLR requirement waiver, according to Iowa Commissioner Susan Voss. It is unclear how many other states could follow suit.

NAIC Vice President Kevin McCarty, the Florida insurance commissioner, said he will hold a hearing in his state Friday to gather evidence about arguments that the minimum MLR requirements will cause disruption.

McCarty said Jay Angoff, director of the HHS Office of Consumer Information and Insurance Oversight, needs more to go on than reports of “amorphous displeasure” in the marketplace.

Some carriers might simply have trouble adapting to the new paradigm, and “we might lose some of those players,” McCarty said he told Sebelius.
:no:
 
Good article BUT, aren't most of the MLR provisions "set to take effect on or after Jan 1 2014" actually set to take effect on or after Jan 1 2011?
 
This MLR REFUND provision in itself could drive some companies out of business.

If a company spends 17% of its incoming individual policy premium dollars on non-medical expenditures in 2011, it must pay 2% of those monies to customers in the form of a rebate. Calculating the rebate, printing checks, stamping, mailing, and filing the mandatory fed report will add administrative costs, which may deem that a second wave of rebates must be sent out...and this continues until the companies says, "SCREW YOU UNCLE SAM" and gets out of the health insurance business all-together.

Three companies have told our MGA that they are considering doing this...just as many on this forum are considering focusing solely on other areas of the insurance industry, or other industries all-together.

-AC
 
The 1099 requirement on companies that purchase more than $600 worth of supplies or services is just as onerous on businesses not in the insurance business.

Programmers refer to Microsoft software as spaghetti programming. This is the equivalent in lawmaking. No wonder people say you should never watch sausage or laws being made.

Just yesterday Obummer gave a speech touting the benefits of Obamacrap and in his speech he talked about premiums coming down.

Just what is this guy, and the folks who believe his every word, smoking?
 
When I get time later this morning I will post the newest news regarding MLR.

32 insurance commissioners have asked Obama to "scale in" the MLR requirement over years instead of on 1/1/11 so as not to create "disruptions in the insurance marketplace".

May well end out with full MLR by like 2018.
 
When I get time later this morning I will post the newest news regarding MLR.

32 insurance commissioners have asked Obama to "scale in" the MLR requirement over years instead of on 1/1/11 so as not to create "disruptions in the insurance marketplace".

May well end out with full MLR by like 2018.

How can Obama modify what was passed by the Congress? If changes can be made, then why pass a bill?

Apparently we have to pass it to know how much we need to change.

Rick
 
32 insurance commissioners have asked Obama to "scale in" the MLR requirement

Are you referring to this?

State insurance regulators told the White House on Wednesday that health insurance markets in some states would be disrupted unless President Obama gave insurers a temporary dispensation from one major provision of the new health care law.

If changes can be made, then why pass a bill?

They had to pass the bill so they would know what was in it . . .
 
Thanks Bob.

State Insurance Commissioners Ask Administration To Phase In MLR Provision.
The New York Times (9/23, B5, Pear) reports, "State insurance regulators told the White House on Wednesday that health insurance markets in some states would be disrupted unless President Obama gave insurers a temporary dispensation from one major provision of the new healthcare law," namely, the medical loss ratio (MLR) provision which "requires insurance companies to spend at least 80 cents of every premium dollar on medical care, rather than administrative expenses, executive salaries and profits." As it stands, "if insurers do not meet the requirement in 2011, they will have to pay rebates to consumers in 2012." But, over "30 state insurance commissioners" met with Obama on Wednesday, and urged him "to consider phasing in the 80 percent requirement over several years, to avoid disruption of insurance markets for individuals and small businesses."

The Hill (9/23, Pecquet) says in its Healthwatch blog, "Insurance commissioners from 32 states, two territories and the District of Columbia met with the Health and Human Services Secretary Kathleen Sebelius, Labor Secretary Hilda Solis and White House Office of Health Reform Director Nancy-Ann DeParle, with President Obama stopping by half-way through."



CQ HealthBeat (9/23, Norman, subscription required) reports, "Two states -- Maine and Iowa -- have asked the Obama administration for more time in implementing a key provision in the healthcare law that spells out how much health insurers must spend on medical care and quality improvements, state insurance commissioners said after a White House meeting with the president on Wednesday." In addition, "a third state, Florida, is gathering additional concrete information and evidence to submit to the administration to bolster its case."



The Hill (9/23, Pecquet) notes in its Healthwatch blog, "Iowa has asked federal regulators to give its individual market health plans until 2014 to comply with the healthcare reform law's medical loss ratio requirement. The law requires the plans to spend at least 80 percent of premiums on care starting next year." In a letter to HHS Secretary Kathleen Sebelius, Iowa's insurance commissioner wrote, "Iowa enjoys some of the lowest health insurance rates in the country. ... Already we are seeing several of our carriers with small numbers of insureds in the individual market announce their intent to cease business in our state. This will impact the choices available to Iowa consumers."
 
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