Word: healthfulness
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Insurance companies have a very technical term for this proportion - "medical loss ratio" (MLR) - and critics say the terminology itself illustrates the callousness of the health insurance business. Companies that sell coverage consider revenues that go to pay for medical costs "losses,"; minimizing these losses by dropping sick customers and cherry-picking healthy ones is one way insurers currently stay profitable. But thanks to a provision inserted into the Senate health care bill at the last minute, the federal government may soon require insurers to "lose" 80% of premiums collected in the large group market and 85% in the individual...
...original Senate bill called for lower thresholds - 75% and 80% respectively - while the House bill calls for an 85% limit across the board; crucially, both of those bills would have ended the requirement in 2013, the year much of health reform only begins to take effect, while Reid's new provision would maintain the regulation in perpetuity. Former Democratic National Committee Chairman Howard Dean, who had advocated killing the public option-less Senate bill, said Monday on MSNBC that of the last-minute changes to the Senate bill made by Reid, the strengthening of the MLR regulations was "the most...
...administrative costs like marketing, salaries and profit. "If you buy a gallon of milk and you end up with half a gallon, you're not really happy about that. But in that case, you can take it back to the store and get mad." (See the top 10 health care reform players...
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...