Estimating the Impact of the Medical Loss Ratio Rule: A State-by-State Analysis

April 5, 2012 | Volume 7

Authors: Mark A. Hall, J.D., and Michael J. McCue, D.B.A.
Contact: Mark A. Hall, J.D., Fred D. and Elizabeth L. Turnage Professor of Law, Wake Forest University School of Law, mhall@wfu.edu
Editor: Deborah Lorber

Feature

medical loss ratio Estimated Rebates

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Overview

One of the most visible consumer protections in the Patient Protection and Affordable Care Act is the requirement that health insurers pay out at least 80 percent to 85 percent of premium dollars for medical care expenses. Insurers that pay out less than this minimum “medical loss ratio” (MLR) must rebate the difference to their policyholders, starting in 2011. Using insurers’ MLR data from 2010, this issue brief estimates the rebates expected in each state if the new rules had been in effect a year earlier. Nationally, consumers would have received almost $2 billion of rebates if the new MLR rules had been in effect in 2010. Almost $1 billion would be in the individual market, where rebates would go to 5.3 million people nationally. Another $1 billion would go to policies covering about 10 million people in the small- and large-group markets.

Citation

M. A. Hall and M. J. McCue, Estimating the Impact of the Medical Loss Ratio Rule: A State-by-State Analysis, The Commonwealth Fund, April 2012.