HomeLatest ThreadsGreatest ThreadsForums & GroupsMy SubscriptionsMy Posts
DU Home » Latest Threads » Forums & Groups » Main » General Discussion (Forum) » Here's why the health car...
Introducing Discussionist: A new forum by the creators of DU

Sat Mar 31, 2012, 06:05 PM

Here's why the health care law's MLR rule is significant

Medigap Medical Loss Ratio Improvement Act

Posted by Don McCanne MD on Wednesday, Jul 27, 2011

<...>

Meanwhile, the industry is on the verge of gutting the medical-loss ratio (MLR) rule. The MLR requires insurance companies to spend at least 80 percent of premiums on medical care – and if they don’t, the money must be rebated to policyholders.

Insurers hate the MLR rule for obvious reasons – they want to spend less on providing actual health care so they can increase returns for profits and salaries for executives. So lobbyists have been hard at work twisting arms at the state and federal level.

They may have gotten their way. The National Association of Insurance Commissioners (NAIC) – an organization representing the chief insurance regulators in all 50 states – voted to send a resolution to Congress in support of suspending or changing the calculation of the MLR.

If Congress agrees, $1 billion in expected rebates would be cancelled and the MLR rule voided. Lynn Quincy of the watchdog group Consumers Union said of the decision: “This is a serious setback in the struggle to protect consumers. … It is also a step back for working families.”

- more -
http://www.pnhp.org/news/2011/december/less-care-for-fewer-and-fewer

The fact is this is a huge change, and the insurance companies didn't get their way.

HHS ensures consumers get better value for their health insurance dollar
http://www.hhs.gov/news/press/2012pres/02/20120216b.html

Here is PNHP commenting on a similar proposal to change Medigap.

Medigap Medical Loss Ratio Improvement Act
Posted by Don McCanne MD

Rep. Stark, Sen. Kerry Introduce Bill to Provide Medicare Beneficiaries Better Value for Their Medigap Premium Dollars

Congressman Pete Stark
Press Release, July 26, 2011

Today, Rep. Pete Stark (D-CA) and Sen. John Kerry (D-MA) introduced the Medigap Medical Loss Ratio Improvement Act. The legislation improves consumer protections in the Medigap marketplace by raising the minimum percentage of premium dollars that must go toward medical care, not executive compensation or administrative costs. This percentage is called the medical loss ratio (MLR).

Under current law, Medigap insurers are required to meet an MLR of only 65 percent in the individual marketplace and 75 percent in the group market. The Medigap Medical Loss Ratio Improvement Act would require Medigap insurance plans to spend at least 85 percent of every premium dollar on medical care in the group market and 80 percent in the individual market.

http://www.stark.house.gov/index.php?option=com_content&view=article&id=2260:press-release-stark-kerry-introduce-bill-to-provide-medicare-beneficiaries-better-value-for-their-medigap-premium-dollars&catid=82:press-releases-2011&Itemid=62

And…

The Hill
July 26, 2011

The insurance industry opposes Kerry and Stark’s bill.

The healthcare law’s MLR requirements didn’t extend to Medigap because it’s a form of supplemental coverage, said Robert Zirkelbach, a spokesman for America’s Health Insurance Plans.

As supplements, Medigap plans collect lower premiums than comprehensive policies, but the administrative costs aren’t necessarily lower. Extending the 80 to 85 percent MLR standards to Medigap would disrupt coverage with which seniors are satisfied, Zirkelbach said.

http://thehill.com/blogs/healthwatch/health-insurance/173623-aarp-backs-bill-to-extend-new-rules-on-insurers-spending

<...>

The insurers are really in a bind. They can’t reduce their administrative services, yet, because the plans are only supplements, they can’t pay out much more in benefits. Requiring the same medical loss ratios as apply to comprehensive plans would likely destroy the Medigap model, and insurers would have to withdraw these plans.

That would be good since these plans are such a terrible value no matter how you cut it. But we have to keep in mind why these plans exist. Medicare benefits are inadequate, leaving beneficiaries exposed to excessive costs. To eliminate this wasteful private industry of Medigap plans, the appropriate solution would be to reduce or preferably eliminate the out-of-pocket cost sharing of Medicare.

Although that reintroduces the “moral hazard” issue of “free” health care, other nations have shown that comprehensive “free” health care can be provided at much lower costs than ours. If we’re going to talk about morality, then we should ask, what is moral about injecting an expensive, superfluous, worthless industry into our health care?

This legislation is important because it identifies the problem of excessive administrative waste, which adds even more to our very high health care costs. But rather than this bill, we really do need an improved Medicare for all.

http://pnhp.org/blog/2011/07/27/medigap-medical-loss-ratio-improvement-act/

No matter how anyone tries to downplay the MLR change, it's significant.

The Bomb Buried In Obamacare Explodes Today-Hallelujah!
http://www.forbes.com/sites/rickungar/2011/12/02/the-bomb-buried-in-obamacare-explodes-today-halleluja/

Wendell Potter Agrees: Big-Profit Health Insurance Almost Dead
http://www.democraticunderground.com/1002390746

24 replies, 2487 views

Reply to this thread

Back to top Alert abuse

Always highlight: 10 newest replies | Replies posted after I mark a forum
Replies to this discussion thread
Arrow 24 replies Author Time Post
Reply Here's why the health care law's MLR rule is significant (Original post)
ProSense Mar 2012 OP
cbayer Mar 2012 #1
ProSense Mar 2012 #2
CAPHAVOC Mar 2012 #3
ProSense Mar 2012 #4
CAPHAVOC Mar 2012 #6
ProSense Mar 2012 #8
CAPHAVOC Mar 2012 #18
cbayer Mar 2012 #5
CAPHAVOC Mar 2012 #7
ProSense Mar 2012 #9
CAPHAVOC Mar 2012 #10
ProSense Mar 2012 #12
CAPHAVOC Mar 2012 #19
cbayer Mar 2012 #11
ProSense Mar 2012 #13
cbayer Mar 2012 #14
CAPHAVOC Mar 2012 #20
eridani Mar 2012 #15
ProSense Mar 2012 #16
eridani Mar 2012 #17
ProSense Mar 2012 #21
eridani Apr 2012 #22
ProSense Apr 2012 #23
eridani Apr 2012 #24

Response to ProSense (Original post)

Sat Mar 31, 2012, 06:11 PM

1. Exactly and I really don't get how anyone thinks this is a reason to bash

the ACA.

So short sighted.....

Reply to this post

Back to top Alert abuse Link here Permalink


Response to cbayer (Reply #1)

Sat Mar 31, 2012, 06:31 PM

2. Because

"Exactly and I really don't get how anyone thinks this is a reason to bash"

...the law has to be portrayed as having nothing good in it. It represents the biggest expansion of Medicaid since its inception, covering all low-income individuals for the first time ever and increasing the income limits, but I'm sure there is a way to misrepresent that too.


Reply to this post

Back to top Alert abuse Link here Permalink


Response to cbayer (Reply #1)

Sat Mar 31, 2012, 07:12 PM

3. 20,000 pages of expensive regulations.

 

Vs. A 50 page Bill expanding medicare to all and eliminating insurance companies.

Reply to this post

Back to top Alert abuse Link here Permalink


Response to CAPHAVOC (Reply #3)

Sat Mar 31, 2012, 07:19 PM

4. Well,

20,000 pages of expensive regulations.

Vs. A 50 page Bill expanding medicare to all and eliminating insurance companies.

Medigap is a supplemental to Medicare. Medicare would have to be completely retooled to serve the non-senior population.

It would be easier to move to single payer.

Reply to this post

Back to top Alert abuse Link here Permalink


Response to ProSense (Reply #4)

Sat Mar 31, 2012, 07:25 PM

6. Why?

 

It pays 80% of part B and 100% of part A. Thats good enough for me. I'll take it.

Reply to this post

Back to top Alert abuse Link here Permalink


Response to CAPHAVOC (Reply #6)

Sat Mar 31, 2012, 07:35 PM

8. You don't

"It pays 80% of part B and 100% of part A. Thats good enough for me. I'll take it."

...seem to understand the point. There are issues.

A Medigap policy is health insurance sold by private insurance companies to fill the "gaps" in Original Medicare Plan coverage. Medigap policies help pay some of the health care costs that the Original Medicare Plan doesn't cover. If you are in the Original Medicare Plan and have a Medigap policy, then Medicare and your Medigap policy will each pay its share of covered health care costs.

https://www.cms.gov/Medigap/

Frankly, "good enough" for you doesn't resolve the problem.

Single payer would.

Reply to this post

Back to top Alert abuse Link here Permalink


Response to ProSense (Reply #8)

Sat Mar 31, 2012, 10:22 PM

18. Medicare is he payer.

 

Singular that is. It is a really good plan for health care. I will take it now!

Reply to this post

Back to top Alert abuse Link here Permalink


Response to CAPHAVOC (Reply #3)

Sat Mar 31, 2012, 07:24 PM

5. A bill that could get through Congress vs. a bill that had not a prayer.

This door needed to be kicked open and Medicare isn't ready to be the single payer/provider by a long shot. It will be a few years down the road, but it is nowhere near ready. To think otherwise is a pipe dream.

Reply to this post

Back to top Alert abuse Link here Permalink


Response to cbayer (Reply #5)

Sat Mar 31, 2012, 07:26 PM

7. Change Congress!

 

Reply to this post

Back to top Alert abuse Link here Permalink


Response to CAPHAVOC (Reply #7)

Sat Mar 31, 2012, 07:40 PM

9. What a

"Change Congress!"

...great and unique concept. I'm in: I'd like to change Congress to 65 progressive Democrats in the Senate and at least 220 in the House.

Problem solved!

Reply to this post

Back to top Alert abuse Link here Permalink


Response to ProSense (Reply #9)

Sat Mar 31, 2012, 07:53 PM

10. Might happen once the people get a load of Romney.

 

If unimpeded by the GOP what do you think the health bill would have been. Or do you think the Big Insurance would get to them too.

Reply to this post

Back to top Alert abuse Link here Permalink


Response to CAPHAVOC (Reply #10)

Sat Mar 31, 2012, 07:57 PM

12. Here's

Might happen once the people get a load of Romney.

If unimpeded by the GOP what do you think the health bill would have been. Or do you think the Big Insurance would get to them too.

...my response: http://www.democraticunderground.com/?com=view_post&forum=1002&pid=499078

In other words, it's moot because there aren't 65 progressive Democrats in the Senate.



Reply to this post

Back to top Alert abuse Link here Permalink


Response to ProSense (Reply #12)

Sat Mar 31, 2012, 10:23 PM

19. Just a question.

 

If you can not answer do not bother.

Reply to this post

Back to top Alert abuse Link here Permalink


Response to CAPHAVOC (Reply #7)

Sat Mar 31, 2012, 07:55 PM

11. Well, yeah, no kidding. I'm trying to do that. How about you?

Reply to this post

Back to top Alert abuse Link here Permalink


Response to cbayer (Reply #11)

Sat Mar 31, 2012, 08:47 PM

13. Isn't it odd

that this is the only point made in response to this OP?

Where is everyone?

Reply to this post

Back to top Alert abuse Link here Permalink


Response to ProSense (Reply #13)

Sat Mar 31, 2012, 08:51 PM

14. I think this is too technical and not inflammatory enough.

Reply to this post

Back to top Alert abuse Link here Permalink


Response to cbayer (Reply #11)

Sat Mar 31, 2012, 10:26 PM

20. Not yet. It has just come to me recently.

 

I am going to do the regular thing first and write to my Reps. But i have been talking it up to friends an they all like the idea.

Reply to this post

Back to top Alert abuse Link here Permalink


Response to ProSense (Original post)

Sat Mar 31, 2012, 09:19 PM

15. Regulation by MLR has been tried already in 15 states

It has failed abjectly in every one of them.

Reply to this post

Back to top Alert abuse Link here Permalink


Response to eridani (Reply #15)

Sat Mar 31, 2012, 09:26 PM

16. Seems like

Regulation by MLR has been tried already in 15 states

It has failed abjectly in every one of them.

...a good reason for the federal government to step in.

Reply to this post

Back to top Alert abuse Link here Permalink


Response to ProSense (Reply #16)

Sat Mar 31, 2012, 10:15 PM

17. HCR leaves actual enforcement of regulation to the states

In countries that have universal health care and also private insurance, the government explicitly dictates costs and coverage to insurance companies. HCR does not do this.

Reply to this post

Back to top Alert abuse Link here Permalink


Response to eridani (Reply #17)

Sat Mar 31, 2012, 11:01 PM

21. No

"HCR leaves actual enforcement of regulation to the states"

...there is federal oversight.

http://cciio.cms.gov/

http://www.healthcare.gov/law/resources/reports/rate-review03222012a.html

Reply to this post

Back to top Alert abuse Link here Permalink


Response to ProSense (Reply #21)

Sun Apr 1, 2012, 02:21 AM

22. Which is meaningless. It is nothing but a list of very naughty boys and girls.

And if they don't shape up, they'll make the list of very naughty boys and girls next year.

Reply to this post

Back to top Alert abuse Link here Permalink


Response to eridani (Reply #22)

Sun Apr 1, 2012, 01:50 PM

23. That's

Which is meaningless. It is nothing but a list of very naughty boys and girls.

And if they don't shape up, they'll make the list of very naughty boys and girls next year.

...absolute nonsense.


Conclusion

The enactment and enforcement of medical loss ratio requirements, along with other important measures for holding insurers accountable, can help make premiums affordable for consumers in all 50 states.

http://www.familiesusa.org/summit-watch/medical-loss-ratios.pdf


Reply to this post

Back to top Alert abuse Link here Permalink


Response to ProSense (Reply #23)

Mon Apr 2, 2012, 12:54 AM

24. Enforcement is strictly up to the states

The original House bill had a federal regulatory body, but the Senate eliminated that. If regulation by MLR is so great, why have insurance premiums doubled despite the fact that 15 state have already tried this?

Reply to this post

Back to top Alert abuse Link here Permalink

Reply to this thread