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PPACA: Rockefeller Lobbies for Tight MLR Rules

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WASHINGTON BUREAU — Sen. Jay Rockefeller today failed to get federal and state insurance regulators to say how they will interpret the new health insurance administrative cost limits.

During an appearance before an independent health care advisory group, Rockefeller, D-W.Va., indicated that he would renew the battle for a government-run “public option” health plan if the minimum medical loss ratio (MLR) provisions of the Patient Protection and Affordable Care Act (PPACA) are watered down.

But state insurance regulators and Jay Angoff, director of the new Office of Consumer Information and Insurance Oversight (OCIIO) at the U.S. Department of Health and Human Services (HHS), kept quiet about how they will interpret the minimum MLR provisions in regulations implementing PPACA.

The new MLR provisions will require at least 80% of individual and small group plan premium revenue and 85% of large group premium revenue to be spent on health care and quality improvement efforts.

Brian Webb, manager of health policy and legislation for the National Association of Insurance Commissioners, Kansas City, said the NAIC hopes to complete work on an MLR “blank” by “the end of summer, hopefully by Sept. 23.”

Angoff said in response to Rockefeller’s opening statement only that, “There still remains a lot of work to be done on MLR.”

The speakers appeared at a briefing organized by the Alliance for Health Reform, Washington, a group funded by the Robert Wood Johnson Foundation, Princeton, N.J. Rockefeller is a charter member of the alliance.

Rockefeller said he would not let health insurers “water down” the MLR mandate by defining health care quality expenses as medical care costs.

Rockefeller said agreed to having an MLR provision in PPACA only as an alternative to creating a public option.

“Implementation matters,” Rockefeller said. “It is the ball game.”

Health insurers are looking at ways to “whittle the MLR down,” Rockefeller said.

Ira Loss, a health care regulatory specialist at Washington Analysis, Washington, said he does not believe that Rockefeller has the votes to create a public option.

Len Nichols, a professor of health policy at George Mason University, said PPACA is really about the fact that “business is usual is over” in health care delivery “because we can’t afford it and the system is failing more of us each year.”

“We must make the health care system work for all of us.” Nichols said.


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