The National Association of Insurance Commissioners is scheduled to vote Thursday on regulations governing the law's medical-loss ratio, which requires insurers to spend 80 percent to 85 percent of premiums on medical spending or activities that improve care. Liberals by and large approve of the regulations that have been adopted by several NAIC subcommittees so far but worry about intense last-minute lobbying to water them down.

"Insurance commissioners have a choice," said Carmen Balber, the Washington, D.C., director of California-based Consumer Watchdog. "Send the current modest version of medical spending regulations to (the Department of Health and Human Services for certification), or give insurers free rein to continue spending too much money on bloated profits and paper-pushers and not enough on actual healthcare."

Consumer Watchdog in particular objects to insurers' request that they be allowed to:

• Aggregate medical spending across state lines, which would allow them to spend less than the minimal ratio in some areas as long as it's made up elsewhere;
• Adjust for annual fluctuations in healthcare spending; and
• Count expenses such as broker commissions, fraud prevention and claims handling as medical rather than administrative costs.

Consumer Watchdog wants President Obama to issue an executive order freezing premium increases until new rules on medical loss and public disclosure kick in.

Health Care for America Now is also calling on the NAIC to "resist intense lobbying" by the health insurance industry. In a press statement Wednesday, HCAN Executive Director Ethan Rome points to Tuesday's announcement by UnitedHealth of a 23 percent surge in third-quarter profits (to $1.28 billion) over last year as proof that tougher regulations are needed.

"UnitedHealth's stunning profit report yesterday," Rome said in a statement, "reminds us that insurance companies have billions of reasons to try to gut rules that end their practice of spending too few premium dollars on actual medical services while denying people the health care they need and charging us more."