Senator Jay Rockefeller IV (D-WV), chair of the U.S. Senate Committee on Commerce, Science, and Transportation, has continued his battle with insurance companies on the issue of medical loss ratio (MLR) disclosure. (MLR is the percentage of revenues used to cover medical services; generally, the lower the MLR, the more profitable the plan). In a letter to U.S. Department of Health and Human Services Secretary Kathleen Sebelius and Commissioner Jane Cline, Chair of the National Association of Insurance Commissioners (NAIC), Rockefeller explained his concern that insurance companies are fighting consumer protections regarding MLR provisions in the health care reform law.

In the letters to Sebelius and Cline, Rockefeller wrote that "there was no doubt" that the insurance industry is shifting focus to influencing how the health care reform law is implemented, particularly for medical loss ratio minimums. "I believe that medical loss ratio information should be aggregated at a level that will be useful for consumers shopping for individual or group coverage in a specific market area," Rockefeller said. "I also believe that health insurance companies must be able to prove that a particular expense actually improves health care quality before insurers can count it as a medical expense."

Rockefeller suggested that HHS require insurers to report their MLR information at a "level of aggregation that would allow consumers living in a particular state or other definable geographic region to determine how insurers are spending their health care premium dollars." He also suggested that HHS should ground a definition of "quality-improving activity" (of the medical loss ratio provision) in existing research that the Agency for Healthcare Research and Quality has performed with non-governmental entities. In addition, he suggested to Cline that insurers provide separate MLR information for the individual, small and large group market segments.

Adapted in part from Senator Rockefeller's press release.

The Senator's press release, with a link to his letter, can be accessed at: http://rockefeller.senate.gov/press/record.cfm?id=324797&

More Industry Headlines