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Health plan association says state insurance commissioners' proposal is bad medicine Posted: October 20th, 2010

By Maryalene LaPonsie

Next year, health reform regulations will require insurers to spend 80-85 percent of their premiums on health care costs. The National Association of Insurance Commissioners (NAIC) recently announced its recommendation for how to enforce this provision, but an industry group says that the commissioners' proposal is not what the doctor ordered.

When health reform passed the U.S. Congress in March 2010, one of its provisions required the NAIC to create a model proposal for calculating medical loss ratios (MLR). These ratios are used to calculate whether health insurance companies are meeting the 80-85 percent requirement imposed by health reform.

At its fall national meeting, the NAIC approved a formula for MLR that defines, among other things, which services can be considered health care. An industry group, America's Health Insurance Plans (AHIP), blasted the proposal as defining health care services too narrowly and being counter to the Obama Administration goal of increasing consumer access to health care.

In a statement, AHIP President and CEO Karen Ignagni said, "The current MLR proposal will reduce competition, disrupt coverage, and threaten patients' access to health plans' quality improvement services."

The NAIC proposal now goes to the Department of Health and Human Services for review.