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ProSense Donating Member (1000+ posts) Send PM | Profile | Ignore Sat Dec-03-11 09:45 AM
Response to Reply #130
179. Fiction.
Facts.

The MLR was never enforced. Medicare has an MLR of about 97 percent. Private insurers were never any where as efficient as Medicare.

At the time, Wendell Potter was fighting for the passage of the legislation. He made some valid points, but some of these were pure hyperbole.

Wendell Potter Says Franken Bill Will Go Far to Control Medical Costs

<...>

When Wall Street isn't calling the shots, the outcome is decidedly better for health care consumers. Government-operated plans, such as Medicare, and some organizations that provide coordinated care, consistently maintain higher medical loss ratios. Kaiser had a 90.6 percent MLR in 2007. Between 1993 and 2007, Medicare's MLR hasn't dropped below 97 percent.

<...>


Potter: Consumers Win an Important Battle Against Insurers, Thanks to State Insurance Commissioners

<...>

Good News for Consumers

Today I can say that I am proud to have been one of 28 people selected by the NAIC to represent the interests of consumers this year. The NAIC's vote this morning is clear evidence that the commissioners listened to us. We didn't win all the arguments over the past six months -- the work the NAIC approved this morning represents a compromise between the interests of consumers and the insurance industry -- but we won many of the important ones. The recommendations that will go to HHS will make it easier for insurers to meet the MLR minimums, there's no doubt about that, but they will also help to ensure that most of what we pay in premiums for health coverage will actually go to pay for medical care, not insurance company shareholders and executives. That is a big victory for consumers.

P.S.: While all of the consumer representatives to the NAIC made important contributions to the debate and the final outcome on the NAIC's MLR work, I would like to thank one consumer rep in particular. Tim Jost, professor of law at William & Lee University, was our big gun. No one knows health-care law, and the Affordable Care Act of 2010 in particular, better than Tim. He devoted countless hours to making sure consumer interests were heard and heeded. Commissioners frequently asked for Tim's opinions on the often obscure matters being discussed during seemingly endless conference calls over many months. So before you send a thank-you note to your state insurance commissioner, send one to Tim. He is a true champion of the consumer.

P.P.S.: As expected, some critics of the MLR provision -- including, of course, America's Health Insurance Plans, one of the industry's big lobbying and fear-mongering groups -- were quick to condemn the NAIC's actions, claiming it would reduce consumer choice and health plans' incentive to improve quality. AHIP president Karen Ignagni warned of dire consequences. "Defining health care quality initiatives in a way that is too narrow or static will turn back the clock on progress and create new barriers to investment in the many activities that health plans have implemented to improve health care quality," Ignagni wrote in a statement after hearing of the NAIC's vote this morning. "More specifically, we want to highlight our recommendations for modifying the definition of health care quality initiatives to include fraud prevention and detection programs and the initial startup costs associated with implementing the new ICD-10 coding system."

Nonsense. These regulations will not take away the incentive for health plans to root out fraud and abuse. They already have installed amazingly sophisticated IT systems to detect fraud. I know because I used to write press releases about them. Health plans will not unplug those systems just because they can't categorize their fraud-busting efforts as activities that improve the quality of care. As for expenses related to implementing the new ICD-10 coding system, insurers are required by law to implement them, and not a minute too soon. Every other health-care system in the developed world has already put the ICD-10 system in place.

The new MLR regulations might indeed cause a few inefficient health plans to either improve the way they do business or close up shop, but why is that a bad thing? Because it will "reduce choice?" One of the main objectives of reform is to reduce waste and ensure Americans get the value they deserve when they send in their premium payments every month. If the health plans that take our money but give us lousy coverage in return are forced out of the marketplace, I say good riddance, even if their departure means that the bigger and more efficient plans that offer better value pick up the customers they leave behind.

<...>

The NAIC was trying to reduce the MLR: Insurance Commissioners Call For Another Look at Medical Loss Ratio

The current MLR is a big deal because it's part of comprehensive reform, which includes rate reviews, regulators and other enforcement mechanisms.

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