EQUAL to NAIC: Regs for the public, not $ for insurance co.s

EQUAL: MLR Regs Should Advance Public Health

The EQUAL Health Network sent a letter from public health leaders on Aug. 16 to the Secretary of Health and Human Services, and the National Association of Insurance Commissioners.  Click above to see the full letter.  Introduction and signers below, including American Medical Women’s Association, Stephen M. Shortell, Ph.D. Dean, School of Public Health, UC – Berkeley:

The Affordable Care Act (ACA) empowers the Secretary to implement the law in a way that benefits the public. The National Association of Insurance Commissioners (NAIC) is set to approve proposed regulations on August 17, which will then be subject to your approval, on the key issue of Medical Loss Ratios. We are concerned that the standards now proposed by the NAIC will frustrate the aims of the law and instead give undue weight to the views and interests of the insurance industry.[1]   As public health professionals and leaders, we urge you to critically review and modify the NAIC’s proposals to HHS in ways that best assure affordable and accessible health insurance.

Section 2718 of the ACA establishes minimum Medical Loss Ratios (MLR) to “bring down the cost of health care coverage” and “ensure that consumers receive value for their premium payments.” It requires health insurance companies in the large market to spend at least 85% of premiums on patient care, and only 15% on administration and profit. In the small group/individual market, the figures are 80% MLR and 20% for administration and profit.

The success of the minimum MLR depends largely on how it is defined. The MLR is a ratio, with all medical claims (in the numerator) divided by total premiums (in the denominator). To fairly achieve an 85% MLR, a company would have to show that the amount spent on medical claims (in the numerator) is high relative to premiums.  But companies can frustrate the intent of the law by defining medical claims to include other expenses, including expenses typically considered part of administration.

The NAIC proposal 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 proposal an avenue to inflate charges unduly, and ask you not to accept it. It is urgent that you make it clear that you will act in the public’s interest, not the insurance industry’s or Wall Street’s.

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 the NAIC’s recommendations. The agency has established an effective track record of responding to and rectifying insurance industry abuses. We appreciate your personal commitment to protecting and advancing the public’s interest in access to affordable health care.

We focus in this letter on aspects of the MLR that directly reference public health. We are aware that the NAIC is discussing other issues of concern to public health, including the treatment of taxes in calculating the MLR, and standards for consumer information.

The EQUAL Health Network brings together nationally partners from public health, women’s health, the faith community, seniors and the public 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.

Ellen R. Shaffer, PhD MPH, Co-Director, EQUAL Health Network

Robert Mason, Policy Fellow, EQUAL Health Network

Stephen M. Shortell, Ph.D. Dean, School of Public Health, UC – Berkeley

Joyce Lashof, MD, Dean Emerita, School of Public Health, UC – Berkeley

American Medical Women’s Association, Omega C. Logan Silva, MD, MACP, Professor Emeritus, George Washington University, Past President, American Medical Women’s Association, Chair, Policy and Advocacy Committee, AMWA

Aaron Beckerman, DSW. Steering Committee, Rekindling Reform; Adjunct Associate Professor of Medicine, New York University Medical Center (Retired);

Merton Bernstein, Professor Emeritus, Washington University School of Law

Anne-Emanuelle Birn, MA, ScD, Professor, Canada Research Chair in International Health, University of Toronto

Paula Braveman, MD, MPH, Professor of Family and Community Medicine, Director, Center on Social Disparities in Health, University of California, San Francisco

Helen H. Cagampang, MPP, PhD, adolescent reproductive health, UCB, UCSF

Andrew F Calman, MD, PhD, Associate Clinical Professor of Ophthalmology and Family & Community Medicine, University of California, San Francisco; Founder and National Chair, Physicians for a Democratic Majority

Suzanne B Cashman, ScD, Director of Community Health and Professor, Department of Family Medicine and Community Health, University of Massachusetts Medical School

Flávio Casoy, MD, Resident Psychiatrist, University of California-San Francisco, Delegate, Committee of Interns and Residents-SEIU

Arthur Chen, MD, Senior Fellow, Asian Health Services, Oakland, CA

Merlin Chowkwanyun, PhD-MPH candidate, University of Pennsylvania

Larry Cohen MSW, Executive Director, Prevention Institute

David Egilman MD, MPH, Clinical Associate Professor, Dept. of Family Medicine, Brown Univ.

Carroll L. Estes PhD, Professor and Founding Director, Institute for Health & Aging, UCSF

June Fisher, MD, Director, Training for the Development of Innovative Control Technology Project, UCSF

Paul J. Friedman, MD, Professor Emeritus, University of California, San Diego

John H. Gilman, MD, JD, Former Health Policy Advisor to Senator Paul Wellstone, Principal Consultant, California State Assembly Health Committee (retired)

Jeoffry B. Gordon, MD, MPH

Bob Griss MA, Director, Health Care Policy, Institute of Social Medicine & Community Health

Roma Guy, MSW, Chair Emerita, San Francisco Health Commission

John Iversen, co-founder ACT UP/ East Bay,

Karl A. Keener, JD, Retired Health Care Lawyer, Community Partner, EQUAL Health Network

Nancy Krieger, PhD, Professor, Department of Society, Human Development, and Health, Harvard School of Public Health

Sandra Lang, Life and Health Agent

Deborah LeVeen, PhD, Professor Emerita, San Francisco State University

Donald W. Light, Ph.D., Professor of Public Health and Comparative Health Care, University of Medicine and Dentistry of New Jersey

Robert A. Padgug, PhD, Associate Professor, Public Health and Health Policy & Administration, Brooklyn College and the Graduate School, CUNY

Cynthia A Pearson, Executive Director, National Women’s Health Network, Co-founder, Raising Women’s Voices for the Health Care We Need

Susan M. Reverby, PhD, McLean Professor in the History of Ideas and Professor of Women’s and Gender Studies, Wellesley College

Mona Sarfaty, MD MPH, Chair, Medical Section, American Public Health Association

Mary Scheib MSN FNP, Women’s Health Center, San Francisco General Hospital

Victor W. Sidel, MD, Distinguished University Professor of Social Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York

Marc A. Snyder, MD, FACEP, emergency physician

Sidney J. Socolar, PhD, Chair, National Programs, Rekindling Reform

Gail Sredanovic M.A. Stanford University

John Steen, Immediate Past President, American Health Planning Association

Norma Swenson MPH, Harvard School of Public Health

Walter Tsou, MD, MPH, Past President, American Public Health Association, former Health Commissioner of Philadelphia

Norma Jo Waxman MD, Associate Professor of Family and Community Medicine, University of California San Francisco

Laura Weil, MA, Director, Health Advocacy Program, Sarah Lawrence College

Lawrence D. Weiss PhD MS, Research Professor in Public Health, Emeritus, Editor, Alaska Health Policy Review

Sophia Yen, MD MPH, Adolescent Medicine specialist, Vice President, Society for Adolescent Health and Medicine  (SAHM), Northern California chapter



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