On June 21, the Department of Health and Human Services released figures showing health insurance customers are due rebates totaling $1.1 billion from insurance companies that spent too little of their premium dollars on health care in 2011. These rebates are thanks to the 80/20 “value for premiums” rule in the Affordable Care Act, which requires insurers to spend at least 80 cents of every premium dollar collected in the small group and individual markets on health care (as opposed to lobbying, advertising, executive compensation, and general administration).

HHS also released state by state numbers (available here) for the total amount of rebates and the number of insurance customers who will benefit. These figures include: $123.6 million for 1.3 million consumers in Florida; $86.5 million for 1 million consumers in New York; $61.8 million for 300,000 consumers in Illinois; $43.1 million for 687,000 consumers in Virginia; and $27.9 million for 141,000 consumers in Maryland.

While rebates are not due until August 1, small businesses are already benefiting from the 80/20 rule in another way: it’s been forcing insurers to hold premiums down in attempts to avoid owing rebates to customers. The Main Street Alliance released the following quotes from businesses that are already benefiting from the 80/20 rule in this way:

Louisa McQueeney, CFO of Palm Beach Groves in Lantana, Florida:

“Last November, our health insurance agent called with our renewal: after annual increases of 12 percent, 22 percent, and even 32 percent, our premiums in 2012 were going to increase by a grand total of 0.2 percent. That is, essentially flat. This flat renewal came with exactly the same plan – no dumbing down the coverage, no increase in our deductibles, everything was the same.

 

“I’m thanking ObamaCare’s 80/20 rule for holding my premiums in check. And now, with the new announcement of more than $123 million in rebates due to 1.3 million people in Florida, we may even get a rebate on top of that. For the first time in my twelve years running this business, the health care picture is finally looking up.”

Brian England, owner of British American Auto Care in Columbia, Maryland:

“We renew our insurance in August every year, so around June is when I usually start to get nervous. When we sat down with our agent last summer, I was bracing myself for the bad news. But when he gave us our quotes, my worry turned to disbelief. Our rates were going DOWN 6 percent! I almost fell off my chair.

 

“The first thing I asked was, ‘why?’ I just couldn’t make sense of it. Our agent explained the rate cut was thanks to the medical loss ratio requirement in the Affordable Care Act. The health care law is working for my business. It passes this technician’s inspection test with flying colors.”

Brianne Harrington, owner of The Painted Pot in Helena and a leader with the Montana Small Business Alliance, had an op-ed printed in the Helena Independent-Record making the case for implementing the new value for premiums (medical loss ratio) requirement.

Brianne wrote:

We won’t fix our broken health care system if we allow insurers to cook the books and go on doing business as usual. We need our health insurance companies to approach the premium value requirement as an opportunity to find ways to increase value and cost savings for their members, instead of trying to circumvent it.

Small business owners focus our best energies on providing good value to our customers every day. We deserve and expect nothing less from our health insurance companies.

Click here to read the full op-ed.

If upheld by full NAIC, recommendation would gut MLR requirement, hand almost $1 billion in small business and individual rebates back to insurers

Washington, DC – Today, a work group of the National Association of Insurance Commissioners (NAIC) voted to recommend NAIC endorsement of a legislative proposal that would undermine the Affordable Care Act’s minimum medical loss ratio (MLR) requirement by removing agent and broker commissions and fees from the calculation of administrative costs. The Main Street Alliance released the following statement in response:

Kelly Conklin, owner of Foley-Waite Associates, Inc and a member of the Main Street Alliance Steering Committee:

"Today’s task force vote was a very good vote for big insurance and a very bad vote for small businesses. The task force voted to take almost $1 billion in annual rebates to small businesses and individuals and just hand that money right back to the health insurance companies, no questions asked. That’s a real poke in the eye to Main Street.

"The value for premiums requirement is one of the key benefits of the new health law for small businesses. It should be implemented as written, not undermined to bail out the health insurance companies from having to fix their broken business model. If the full NAIC takes into account what small businesses need, they’ll vote to overturn this misguided recommendation and support the value for premiums requirement as written."

The Main Street Alliance submitted a letter on June 28 to the task force outlining the importance of the MLR requirement for small businesses and urging the task force to recommend no change to the requirement. Download a copy of the letter here.

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One of the key provisions of the Affordable Care Act passed in 2010 was something called a minimum Medical Loss Ratio (MLR) requirement. This requirement establishes a basic level of value for premiums. Insurers either meet that standard or, if they fail to, owe rebates to their customers.

If this requirement had been in effect in 2010, health insurance customers would have received rebates of almost $2 billion from insurers who failed to meet the value for premiums standard. That’s some serious money back in the pockets of small business owners who've paid too much for health care – and a serious incentive for insurers to hold premiums down and increase value in the future.

Predictably, these new requirements have come under attack by industry groups that want to roll them back and allow insurers to continue doing "business as usual." The latest attack is an attempt to remove agent and broker commissions and fees from the value for premiums calculation.

What would that mean for small businesses? This change would wipe out $1.2 billion – more than half – of the potential rebates in the 2010 estimates. And, it would undermine the incentive for insurers to hold premiums down going forward.

The Main Street Alliance submitted a letter to a task force of the National Association of Insurance Commissioners (NAIC) on June 28 outlining the small business case for protecting the value for premiums requirement and implementing the new minimum medical loss ratio standards without changes.

Read MSA’s letter here