Senators are taking action in investigating aspects of health care reform, whether turning attention to particular issues, or questioning effectiveness. Senate Committee on Commerce, Science & Transportation Chairman John D. Rockefeller (D-WV) is continuing his work on accountability in health insurance companies, expanding his investigations into industry policies covering medically necessary care.

Rockefeller has sent letters to the CEOs of the companies Coventry Health Care and Aetna, Inc., in which he requested detailed information concerning policies covering stress tests for their Delaware policyholders who are showing symptoms of heart disease. This action follows reports in Delaware media that insurers are refusing to cover these tests, and that Delaware Insurance Commissioner Karen Weldin Stewart is examining the matter.

"I am encouraged that Commissioner Stewart has launched an investigation into BCBSD's, Aetna's and Coventry's health care practices," Chairman Rockefeller said. "I intend to keep a close watch on the health insurance industry, and to ask the tough questions about how they do business - especially now that we have passed a landmark health care reform bill. Denying medically necessary services to patients showing signs of serious heart disease is not tolerable."

In addition, Chairman Rockefeller's staff has released a report on 2009 medical loss ratio information for policymakers and consumers. As explained in the report, a medical loss ratio is an important aspect of the commercial health insurance industry because the ratio measures the percentage of premium dollars actually spent on health care, as opposed to, for example, administrative costs or advertising costs. If a company uses 80 cents out of every premium dollar for health care, its medical loss ratio is 80 percent. Many States require minimum loss ratios for insurers.

For this report, Chairman Rockefeller had sent letters to the 15 largest health insurers asking for more information on the company's medical loss ratios; however, the report notes that many of these companies responded that the requested medical loss ratio information, categorized by state and market segment, was "proprietary" and "business sensitive." The report said this response was troubling, as the information is useful for consumers purchasing insurance.

The Committee then collected background information for the report from 2008 "Accident & Health Policy Experience Exhibit" forms the insurance companies filed with the National Association of Insurance Commissioners. The Committee's analysis found that the largest for-profit health insurers had a lower medical loss ratio than other health insurers, spending less premium dollars on health care. In addition, for individual and small group markets, health insurers have a smaller medical loss ratio than they do in the large group market.

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