Word: healthfully
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Dates: during 2000-2009
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Rockefeller had been pushing for a 90% threshold, but the Congressional Budget Office said such a requirement would severely limit companies' flexibility and "make such insurance an essentially governmental program." Many states currently have MLR requirements, but most are below the federal level that would be established under Democratic health reform. The existing minimum baseline, established in non-binding guidelines from the National Association of Insurance Commissioners, says that MLRs must be at least in the 50-60% range, depending on what other regulations are in place...
Earlier this year Rockefeller - who is chairman of the Senate Commerce, Science and Transportation Committee - launched an investigation into MLRs. According to Rockefeller, in 2008, insurers in the individual market spent an average of 74% of premiums on health care, compared with 80% in the small group market and 84% in the large group market; some insurers cited in the final report spent as little as 66% of premiums on actual care. CIGNA, one of the insurance companies cited, says investigators erred in calculating the company's medical loss ratios. Where the report said CIGNA spent 87% of premiums...
...might react to new thresholds by "cutting back on efforts to restrain benefit costs through care management." Translation: Anything that doesn't count as "medical costs" may be on the chopping block, including exorbitant executive salaries but also programs to keep patients healthy. There is also a fear among health policy experts that some insurers could raise premiums in reaction - higher premiums means more money spent on health care, but also more left over for profits. Another unintentional consequence might be insurers overpaying for some health services to keep their MLR averages high. All of this means the efficacy...
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