Jan 30 2012
The medical loss ratio rule is in the federal health law.
The Hill: Texas Will Not Receive Healthcare Waiver
The Health and Human Services Department on Friday denied Texas's request for an adjustment to new rules under the healthcare reform law that govern insurers' spending. The law says policies sold to individuals must spend 80 percent of their premiums on medical costs, leaving the other 20 percent for administrative costs and profit. HHS denied Texas's request to phase in that standard over three years. ... HHS has now denied nine states' requests for adjustments, and approved six (Baker, 1/27).
Bloomberg Businessweek: Texas Insurers Won't Get Reprieve From Health-Care Law Rule
Texas Republican Governor Rick Perry's administration had asked the U.S. to let plans led by Blue Cross and Blue Shield of Texas spend less than 80 percent of their premium revenue on patient care. ... Thirty-four companies sell policies to individuals in Texas. Eight carriers who control 85 percent of the individual market have said they'll continue selling after the profit limit is enforced, officials with the U.S. Health and Human Services Department said in denying the request. ... Two states, Wisconsin and North Carolina, have requests outstanding (Wayne, 1/27).
The Associated Press: Federal Government Rejects Texas Insurance Waiver
Texas health insurers will likely pay out $476 million in rebates over the next three years, said Gary Cohen, acting director of oversight at [HHS]. ... The Texas Department of Insurance issued a statement rejecting the federal agency's conclusions, saying it did not give insurance companies time to adjust their business models to new rule. ... The states granted a waiver include four with Republican governors: Maine, Nevada, Georgia and Iowa. The states denied include one with a Democratic governor, Delaware. Florida was denied a waiver (Tomlinson, 1/27).
(Austin) American-Statesman: Feds Deny Texas Waiver On Health Insurance Rules
[O]fficials with the Texas Department of Insurance, who had asked that the rule be phased in over four years, said the decision places an undue burden on insurers, particularly small and midsize firms that may have to write fewer policies or leave the individual market altogether. ... About 725,000 Texans purchase their own health insurance, and almost two-thirds would have qualified for rebates if the standard had been in place in 2010, state figures show (Lindell, 1/27).
Star-Telegram: Some Texas Health Insurers Ordered To Give Rebates
[T]he state asked that the insurers instead be required to meet a lower medical loss ratio, starting at 71 percent in 2011 and rising to 80 percent in 2014. In a statement issued Friday, Richardson-based Blue Cross said it will "fulfill our obligations" under the law, although it said "it would be premature to predict the likelihood of potential rebates." ... The lowest medical cost ratio for a Texas individual-health insurer in 2010 was 49.9 percent by Citizens National Life Insurance Co (Fuquay, 1/27).
 This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.
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Artificial empathy in healthcare platforms and future directions