The fate of the health plans of roughly half of Americans who buy their own policies could be determined by the upcoming battle between federal regulators and House Republican Conference Secretary John Carter.
Carter today introduced H.J. Resolution 103 disapproving the regulation proposed by the Department of Health and Human Services (HHS) requiring all health plans to pay a minimum 80% of premiums towards health services, and for larger insurers to pay a minimum 85%.
"The President repeatedly swore to the American people that if they liked their current plan they could keep it under his bill," says Carter. "But now after the fact HHS issues regulations that will effectively wreck the individual and small group health insurance market. Our national goal should be to increase health coverage for all Americans. This regulation is heading in the exact opposite direction, and must be stopped before it becomes effective."
HHS estimates that about 45% of Americans who buy their own health insurance are in plans that do not meet the new regulation. While most large insurers already meet the proposed new federal medical loss ratio standard due to economies of scale, smaller insurers providing coverage in the individual and small group market are threatened with being forced to pay massive federal rebate payments if their administrative costs exceed 20% in a calendar year, regardless of the profitability of the insurer.
TEXT OF CARTER RESOLUTION:
Disapproving a rule submitted by the Department of Health and Human Services relating to ""Health Insurance Issuers Implementing Medical Loss Ratio (MLR) Requirements
Under the Patient Protection and Affordable Care Act'.
Resolved by the Senate and House of Representatives of the United States of America in Congress assembled, That Congress disapproves the rule submitted by the Department of Health and Human Services relating to ""Health Insurance Issuers Implementing Medical Loss Ratio (MLR) Requirements Under the Patient Protection and Affordable Care Act'' (published at 75 Federal Register 74864 (December 1, 2010)), and such rule shall have no force or effect.