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Reply #26: Health Care Reform Bills - Does Actuarial Value Trump Medical Loss Ratio? [View All]

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Home » Discuss » Archives » General Discussion: Presidential (Through Nov 2009) Donate to DU
slipslidingaway Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Nov-03-09 02:27 PM
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26. Health Care Reform Bills - Does Actuarial Value Trump Medical Loss Ratio?
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http://www.democraticunderground.com/discuss/duboard.ph...

"...But limiting insurers administrative expenses is not necessarily the most beneficial strategy for insureds. Ensuring a high actuarial value of benefits provided would be best. The Congressional Research Service earlier this year reviewed actuarial value issues. The actuarial value provides an estimate of the proportion of health care expenses a plan likely will pay. As the economy has deteriorated, so has the actuarial value of employer-sponsored health insurance. Individuals covered by employer-sponsored health insurance these days get lower actuarial values and less protection..."


"...If there is a cap on out-of-pocket spending, then why should the precise actuarial value make difference? Simply, the lower the actuarial value, the greater the likelihood that the patient will have to spend the full amount up to the cap. Thus more individuals will be negatively impacted. Also, the amount of the cap makes a very big difference. The proposed caps on out-of-pocket spending, when added to the patients share of the premium, create a financial hardship for most low and middle income individuals and families..."
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