NAIC ponders medical-loss ratios while Ohio plans balk at new non-medical expenses

The National Association of Insurance Commissioners (NAIC) in Washington, D.C., failed to meet a June 1 deadline set by U.S. Department of Health and Human Services Secretary Kathleen Sebelius to recommend uniform definitions and standardized methodologies for calculating the medical-loss ratio and rebates included in the Patient Protection and Affordable Care Act (PPACA), reports the Washington Post.

Meanwhile, Sebelius came out of a meeting last week with insurance executives looking to establish a public-private partnership to implement the PPACA, reports the New York Times. And health insurers in Ohio say that including medical-record costs in the medical-loss ratio could give them an incentive to push the state's primary care physicians to install electronic medical records by early 2012, reports the Columbus Dispatch.

The NAIC expects to provide its recommendations "later this summer." The reason for the delay? "The medical-loss ratio and rebate program in PPACA have the potential to destabilize the marketplace and significantly limit consumer choices if the definitions and calculations are too restrictive. Equally, the medical-loss ratio and rebate program could be rendered useless if the definitions and calculations are too broad," said NAIC President Jane Klein and CEO Therese Vaughan in a letter to Sebelius. "Only through an open, deliberative process can we hope to reach a reasonable consensus that meets the dual objectives of protecting consumers and preserving competitive markets."

To learn more:
- read this Washington Post article
- read the NAIC press release and letter to Sebelius
- read the New York Times article
- read this Columbus Dispatch article
- read the American Hospital Association's recommendations to the NAIC

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