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California commissioner receives emergency authority for health insurance rate enforcement Posted: February 3rd, 2011

By Maryalene LaPonsie

On Jan. 1, the Patient Protection and Affordable Care Act (PPACA) federally mandated that most health insurance companies implement medical loss ratios of 80 percent to 85 percent. That means insurers must spend 80 cents to 85 cents of every premium dollar they receive directly on health care services.

While the PPACA set a new federal standard for medical loss ratios, California law only allows its commissioner to reject health insurance rate hikes that don't meet a 70 percent medical loss ratio. To address the difference in state and federal law, California Insurance Commissioner Dave Jones asked for emergency authority to enforce the federal regulation. On Jan. 24, the California Office of Administrative Law (OAL) granted the request, which will remain in place until July 26.

In commenting on the decision, Commissioner Jones said in a statement, "This emergency regulation will give me the legal authority to enforce the new federal 80 percent medical loss ratio for the individual health insurance market in California even if Congress prevents the federal Department of Health and Human Services from enforcing it. I will be watching very closely to make sure health insurers comply."