EQUAL: Stop Insurance Co. Heist

EQUAL Public Health Letter: MLR to Serve Public’s Interest


The Affordable Care Act (ACA) empowers the Secretary to define the Medical Loss Ratio (MLR) in a way that benefits the public.  We urge you to implement regulations that will help to set affordable premiums and bring down health care costs, by providing incentives to the health insurance industry to operate efficiently and to negotiate assertively with health care providers. rather than simply passing on cost increases to consumers.

We are concerned that the standards most recently proposed for review by the National Association of Insurance Commissioners (NAIC) include an edit that would allow the insurance industry to count marketing campaigns performed in conjunction with state and local public health departments as medical expenses. This reference appears in the Medical Loss Ratio (MLR) “Blanks” proposal by the Financial Condition (E) Committee of the NAIC dated June 29, 2010. We consider this an avenue to inflate charges unduly, and ask you not to accept this proposal.

 The NAIC is charged with developing proposed regulations, and reporting its proposals to your office.  We offer these comments in the hope that the NAIC will more equitably balance the interests of the public and of the insurance industry, and we further ask that you, Madame Secretary, make an independent assessment of their recommendations.

 The EQUAL Health Network brings together partners from public health, women’s health, the faith community, seniors and the public on a national basis to advocate for Equitable, Quality, Universal, Affordable health care. We have been active supporters of the ACA, and submitted formal comments on the MLR to HHS on May 14, 2010.

 We outline here a brief summary of the ACA provisions regarding the Medical Loss Ratio, the present proposals under consideration by the NAIC, and recommendations for the HHS’ regulations.  The agency has established a popular track record of responding to and reining in insurance industry abuses.  We appreciate your personal commitment to protecting and advancing the public’s interest in access to affordable health care.

Click here for Ellen Shaffer’s related article on Huffington Post

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