House Republicans yesterday sought to put new pressure on the Department of Health and Human Services (HHS) on the medical loss ratio issue (MLR).

They did so by implying that HHS put inappropriate pressure on the National Association of Insurance Commissioners (NAIC) in 2010 to include agent commissions in the MLR calculations.

Ethan Rome, executive director of Health Care for America Now, reacted to the new effort by saying that, “A year after an exhaustive public process that produced a high-quality, unanimous recommendation on the medical loss ratio, the Republicans in Congress are abusing their power by launching a fishing expedition that questions the insurance commissioners’ integrity.”

Rome added, “Only hyper-partisan Republicans would try to criminalize contact between insurance commissioners and HHS. Why is cooperation prohibited? Why does venom and attack have to be the standard operating procedure? House Republicans need to grow up.”

The new pressure was contained in a letter written to the NAIC officials who participated in writing the original MLR regulations released in October 2010 and approved by HHS several weeks later.

The letter was written by key Republican members of the House Energy and Commerce Committee.

The letter also implied that HHS and NAIC officials might be forced to make written sworn testimony on the issue to the committees at public hearings they might convene.

It follows the decision by HHS on  Dec. 2 to include agents in the MLR calculations in a final regulation despite a resolution adopted by the NAIC the prior week asking that agents be removed from the calculation.

The letter was signed by Rep. Fred Upton, R-Mich, chairman of the Energy and Commerce Committee.; Joseph Pitts, R-Pa., and Michael Burgess, R-Texas, chairman and vice chairman of E&C’s Health Subcommittee; and Cliff Stearns, R-Fla., chairman of the committee’s Subcommittee on Oversight and Investigations.

It was written to Susan Voss, Iowa insurance commissioner and president of the NAIC; Jane Cline, former West Virginia commissioner and NAIC president at the time; and Sandy Praeger, Kansas commissioner and head of the NAIC Task Force that adopted the regulations forwarded to the HHS for implementation.

The letter said the committee had held numerous hearings on the issue where “several witnesses gave testimony regarding the law’s harmful impacts on jobs in the agent and broker community.

“We have also heard testimony regarding the negative impacts of the MLR provision on patient choice in health coverage, as well as its deleterious effects on health care quality and the prevent of fraud,” the congressmen said in the letter.

The letter asked if HHS officials had discussed the MLR regulation with commissioners or staff, and wanted to know which staffers and commissioners participated in such discussions.

The letter also asks whether HHS officials engaged in any communications “with you or any NAIC staff, whether oral or written, which indicated that HHS would refuse to certify in whole or in part the model regulations being considered by the NAIC?”

The letter also asks whether HHS officials provided NAIC commissioners or staff with legal interpretations of activities that may or may not be included within the definition of “activities that improve health care quality,” and “non-claim costs” under provisions of the regulations under attack by the committee.

The committee has introduced two measures supported by the insurance agents. But the panel appears to be unable to win full committee and full House support for the measures. And, Democrats in the Senate are opposed, according to industry officials, as are insurance commissioners in large states, such as California, Washington and New York.

One is H.R. 1206, which would exclude producer compensation from medical loss ratio calculations. Another is H.R. 2077, which would repeal the MLR entirely.

H.R. 1206, sponsored by Rep. Mike Rogers, R-Mich., and John Barrow, D-Ga., has strong support. The bill has 139 co-sponsors. But it has been mired for months in the House.

The Independent Insurance Agents and Brokers of America, the National Association of Health Underwriters and the National Association of Insurance and Financial Advisors have voiced deep concern about including agent commissions in the MLR, and its impact on jobs and revenues in the agent community.

In the latest comment, Leonard Brevik executive vice president of the National Association of Professional Insurance Agents, said he was ”disappointed” with the NAIC decision.

 “Our members who sell health insurance want to continue doing so, but HHS doesn’t seem to value the participation of producers. As a result, Congress must act.”

Brevik said that Congress mandated in the healthcare law that agents and brokers be full participants under the new healthcare law, but “HHS is trying to undo that provision through the regulatory process.”