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PPACA: Comments Reveal Divide on MLR Issue

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SEATTLE — A new medical loss ratio reporting (MLR) form seems to have much wider support at the National Association of Insurance Commissioners (NAIC) than the new minimum MLR requirements.

All members of the NAIC, Kansas City, Mo., who voted Tuesday supported adoption of new medical loss ratio blanks — the forms health insurers will use to report on the percentage of premium revenue they are spending on medical expenses.

The Affordable Care Act, the legislative package that includes the Patient Protection and Affordable Care Act (PPACA) , will require the percentage of premiums going to medical care and quality improvement efforts to be 80% for individual and small group coverage and 85% for large group coverage.

Pennsylvania Insurance Commissioner Joel Ario abstained from voting for approval of the form that insurers will need to comply with the minimum MLR requirement because he is taking a job at the Office of Consumer Information and Insurance Oversight (OCIIO), a new arm of the U.S. Department of Health and Human Services (HHS) that will be in charge of the minimum MLR requirements and other PPACA requirements.

Although support for the form is nearly universal, regulators expressed different views about how well the minimum MLR requirement will serve consumers.

Connecticut Commissioner Thomas Sullivan said the requirement could end up keeping consumers who like their coverage from keeping their coverage.

Connecticut, for example, now has a competitive health coverage market, but the minimum MLR requirement could cause

a small insurer in the state to lose its ability to compete, Sullivan said.

The requirement is intrusive, and health insurance costs cannot be managed effectively until health care costs are addressed, Sullivan said.

Illinois Insurance Director Michael McRaith said his state does not have a competitive health coverage market.

“We are grateful in Illinois” for creation of PPACA, McRaith said.

He gave the example of a woman who was denied coverage for efforts to seek help with dealing with the death of a loved one because she sought grief counseling at her church.

“In Illinois, even grief is a preexisting condition,” McRaith said.

Consumers can choose the car and the home they want to insure, and who to insure it with, “but you cannot choose to have cancer,” McRaith said.


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