As anticipated, the National Association of Insurance Commissioners passed recommendations regarding the medical loss ratio and how it should be implemented. These recommendations now go to the Department of Health and Human Services, which will issue binding regulations. The insurance industry is very unhappy with the recommendations, which categorize insurer spending as either health care or administration. The new law requires insurers to spend 80 or 85 percent of premium dollars on health care and quality improvement. There's a big grey area -- are appeals health related or administrative? What about programs to fight fraud? One of the hottest issues are agent/broker commissions, which the NAIC said are administrative. These grey areas are the thorny issues. We'll see where HHS comes out on all of this eventually, but this is a very positive first step that did not dilute the law to satisfy insurers, while also giving them some of what they wanted.
Meanwhile, the Pre-existing Condition Insurance Plans that were created this summer are off to a slow start. Here's the story of a woman in California who paid her premium in August but still doesn't have coverage, although according to HHS, all of the other states that are running their own plans are up and running. About 20 states -- those who oppose reform, for the most part, have declined to set up Pre-existing Condition Insurance Plans, allowing the federal government to run those plans instead.
And here's a story of a brave woman who fought her health insurer after it left her with a $450,000 bill after her husband lost his battle with cancer. Amazing how people find ways to fight no matter what. Perhaps her story will inspire you a little on this Thursday afternoon. Jennifer