Insurers operating in Nevada and New Hampshire get a reprieve from the medical-loss ratio requirement after HHS granted the two states waivers from the health reform law's provision. The decision represents a "reasonable balance" between recognizing the risks of quick implementation and ensuring that premiums are directed back to policyholders, an HHS official told The Hill’s Healthwatch.
Nevada asked that the MLR requirement, which forces health plans to spend 80 percent of their premium revenues on medical costs, be reduced to 72 percent for one year, arguing that top insurance plans would be so strapped to make the payments that they'd exit the state market. HHS agreed to reduce the requirement to 75 percent for a year, reports the Las Vegas Sun.
In addition, New Hampshire requested an MLR waiver that would allow health plans to only spend 70 percent of premiums on medical costs. HHS instead decided that insurance companies in the state would need to spend 72 percent on healthcare this year, 75 percent in 2012 and 80 percent in 2013 and beyond. HHS explained that although only four companies cover New Hampshire's individual insurance market, the state provided no evidence that Anthem, which controls 70 percent of the market, would leave, according to New Hampshire Public Radio.
HHS has now granted three adjustments to the new rules, as it previously accepted Maine's request for a modified MLR.
But the department has yet to rule on at least seven more waiver applications, including requests from Florida, Kentucky, Louisiana, North Dakota, Georgia, Kansas and Iowa. Indiana just announced that it's seeking a waiver to set the minimum MLR level at 65 percent in 2011, 68.75 percent in 2012, 72.5 percent in 2013, 76.25 percent in 2014 and 80 percent in later years, National Underwriter reports.
The HHS official said negotiations with the states seeking modifications have been productive. "It's gone smoothly," the official said. "It's been a very good process," notes Healthwatch.
To learn more:
- read The Hill’s Healthwatch story
- see the Las Vegas Sun article
- check out the New Hampshire Public Radio piece
- read the National Underwriter story