The worst definitely didn’t happen in Seattle. The National
Association of Insurance Commissioners deferred the
worst insurance industry demands for weakening the implementation of
health care reform. For a body so closely linked to the insurance
industry, that counts as real progress. Credit is due to the
state-level experts who wrote proposed regulations, the consumer representatives and advocates who monitored the process,
pressing for more consumer-friendly interpretations, and some state commissioners who put consumer protection over politics.
Battles
over how insurance companies will account for taxes and perhaps broker
fees (sales commissions) are still to come, but what emerged from the
meeting was a relief–there were few changes to the proposals devloped
by NAIC staff and state insurance analysts and actuaries. One really
irritating proposal to let insurers count their accreditation
fees–which are meant to reassure investors and employers–in the
health care eaquation was even deleted.
Rather than rewrite the
book, I’ll offer the statement issued by Health Care for America Now,
which mounted demonstrations with a local affiliate during two days of
the conference. Highlights included "lobbyist disinfectant: kits with
soap and a mask, a band playing health-reform tunes and a giant
blood-sucking Dracula meant to represent–what else?–insurance
companies. Here’s a photo of one demonstrator hugging
whistleblower-hero Wendell Potter, who was active at the meeting.
Sorry, I missed the Dracula shot.
“Today the NAIC took a step toward ending the health insurance
companies’ stranglehold on our health care. The top state insurance
regulators from across the nation voted to put patient care above
insurance company profits. This decision moves us closer to more
affordable health care for families and businesses and will help ensure
that the new health care law fulfills its promise. Advocates have
battled every step of the way to hold the insurance companies
accountable, and we will continue to do so.“Many challenges remain before we can declare victory in the MLR fight.
Pivotal aspects of the technical rules discussed today in Seattle
remain unresolved, including crucial decisions on how to treat federal
taxes and agent/broker fees. The NAIC still has work to do, and it
should finish its deliberations soon so the Department of Health and
Human Services (HHS) can swiftly develop final rules that take effect
on schedule for 2011 health plans.”
MLR, by the way, means "medical loss ratio." That’s insurer-speak
for how much the companies spend on health care, rather than
administration and profit–and it’s such a telling phrase. Health
reform is supposed to require insurers to spend 80% to 85% of premium
dollars on health care–the MLR. But it all depends on how you define
health care, and how much you can deduct from premium revenue before
you calculate the percentage. That particular battle is way far from over.
