Effective: June 1, 2012
The biggest impact from health care reform consumers may feel in 2012 is actually the result of an initiative that began last year called the medical loss ratio, or MLR. This formula requires health insurance companies to spend at least 80 percent of their premiums on direct medical care or quality improvement or 85 percent for large group-based plans. Those that don't meet the mark must provide a rebate to policyholders.
"The rebates start June 1, and they have to have them issued no later than August 1," says Laurie Sobel, senior attorney for Consumers Union. "The National Association of Insurance Commissioners estimates that Americans would have received nearly $2 billion if MLR had been in effect in 2010."
Zirkelbach's AHIP constituents aren't delighted with the MLR. "Those so-called administrative expenses are going to the types of investments and programs that patients want, that improve care and prevent fraud and make the system work better, like ACOs," he says.
However, Sobel applauds the MLR.
"It's going to provide a lot of relief for consumers," she says. "We're seeing some movement with insurance companies actually lowering premiums or holding down increases in anticipation of this rule."