A Victory for Health Care Implementation

Last week, the National Association of Insurance Commissioners (NAIC) finalized their recommendations to President Obama on how to implement a critical piece of health care reform: medical loss rations. Their recommendation is a significant victory because,  according to the Washington Post, it largely favors “the views of consumer advocates over those advanced by the insurance industry.”

Simply put, the medical loss ratio is the proportion of premiums collected by insurance companies that they must pay out for the actual medical costs of their customers. Starting next year, the new medical loss ration rules will require insurers to spend 80 to 85 percent of premiums on the medical claims that improve the health of their customers. That means that only the remaining 15 to 20 percent will be available to them as profits.

Since the spring,  the NAIC has received plenty of comments and input from both health care advocates and insurance industry lobbyists. This includes a demonstration in July, when NWFCO affiliate Washington CAN! assembled 150 people in downtown Seattle to speak up at the NAIC convention and urge commissioners, who were also joined at their meeting by hundreds of insurance industry lobbyists, to pass strict rules regarding the implementation of health care reform. On the issue of medical loss ratios, the voice of people, not the insurance industry, prevailed.

But the fight isn’t over. The Department of Health and Human Services still needs to finalize the actual rules regarding MLR. While it’s very likely that HHS will enact the recommendations set forth by the state insurance commissioners, there is still one crucial piece of truly equitable health reform that has not been addressed in this debate: language access. NWFCO and affiliates, through the Health Rights Organizing Project, will continue to urge HHS to include language services as a medical expense when calculating the MLR of health insurance companies.

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