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April 05, 2012 at 08:47 AM
If the Patient Protection and Affordable Care Act’s (PPACA) healthcare coverage spending provision commonly known as the MLR or medical loss ratio had been in place in 2010, consumers nationwide would have received an estimated $2 billion in rebates from health insurers, according to an analysis by the Commonwealth Fund, a private healthcare system improvement foundation.
The newly released study estimated how much consumers in each state would have received in total rebates, and the number of insurers that would have been required to give rebates if the rule had applied in 2010.
The $2 billion would have been evenly split between the individual market and the small- and large-group market.
Almost $1 billion, or $965,073,457 in rebates would have been issued to about 5.3 million people who receive coverage through the individual market, or 53% of all those with individual coverage nationwide in 2010, according to the report.
Another $1 billion would have gone to about 10 million people with policies in the small- and large-group markets.
About one-quarter (23%) of privately insured consumers in all markets would have received rebates, the study reported.
Total estimated annual rebates for the top rebate states would have been, according to the study: Texas ($255 million); Florida ($202 million); Virginia ($128 million); Illinois ($112 million); and Maryland ($109 million).
Texas would also have the highest number of insurers, at 15, that would have had to offer a rebate in individual coverage, followed by Illinois, with states like Florida, Pennsylvania and Missouri not far behind, with 10. The report footnote stated that California data was incomplete. In Florida, for example, individual rebates would likely have ranged from $100 to $300.
See also: Interactive Rebate Table
PPACA’s MLR provision requires at least 80% of all health insurance premiums go toward medical costs, leaving 20% for administrative costs. The NAIC’s called on the Department of Health and Human Services and Congress to modify the MLR would also call for holding off on enforcing the MLR, or approving state MLR adjustment requests.
