Insurers' new reality: More for care, less profit

By Parija Kavilanz, senior writer


NEW YORK (CNNMoney.com) -- Insurers were dealt a blow Thursday as state regulators endorsed a tough new law that boosts the amount of premium money they'll have to pay for patient care.

Beginning on Jan. 1, insurance companies will have to spend 80% to 85% of the premiums they collect on medical care instead of toward their own profits and overhead costs.

This spending allotment is known as the "medical loss ratio" and was a key provision of the health care reform law enacted by Congress in the spring.

Currently insurers don't have to meet any minimum requirements in some states. Other states require as little as 40% of premiums to be used for medical care.

Insurers that don't increase that allotment to the new federal standard will have to give customers a rebate for the difference beginning in 2012.

The Department of Health and Human Services still must issue regulations detailing exactly how insurers will have to allocate their premium money. Kathleen Sebelius, head of the agency, said she appreciated the commissioners' recommendation and would release the regulation "in the coming weeks."

Insurers want more time. The insurance industry is afraid that the Jan. 1 deadline is too abrupt and has been pushing for a phased-in approach to implementing the rule through 2014.

The state insurance commissioners agree with the industry. In fact, just last week, the National Association of Insurance Commissioners sent a letter to Sebelius arguing that all states may need a phase-in approach.

"Insurance companies in some markets will need a transitional period to comply with the 80% MLR limit," the group wrote. "In the absence of the transitional period, the markets of some states are likely to be destabilized."

The insurance industry expected the phase-in approach recommendation to be part of Thursday's vote. But the NAIC only voted on the medical loss ratio.

"We're very surprised that the NAIC did not vote today on recommending a transition period given what they wrote in their letter last week," said Robert Zirklebach , spokesman for America's Health Insurance Plans, an industry lobbying organization.

Many insurers are seeking waivers from having to comply on Jan. 1. Sebelius has the final word on granting those requests.

Survival of the fittest. The concern is that many smaller insurers won't be able to meet the new standard by 2011, and could either exit the market or not take any new customers.

The consequence of not phasing in the change would be a "potential disruption of coverage for millions of Americans and reduced competition prior to 2014 market reforms," said Karen Ignagni, president of AHIP wrote in a letter to state insurance commissioners last week.

One industry expert agrees that the new requirement could knock some carriers out of business or force them to drop customers.

"The issue that some carriers will leave the market as a result of this is real," said Deborah Chollet, senior fellow and health economist with Washington-based Mathematica Policy Research.

Even if the smaller carriers exit the market, Chollet said that most individuals will easily be able to find coverage from large carriers who can meet the new standards.

"It's survival of the fittest," she said. "Big carriers can meet the new rule."  To top of page

Frontline troops push for solar energy
The U.S. Marines are testing renewable energy technologies like solar to reduce costs and casualties associated with fossil fuels. Play
25 Best Places to find rich singles
Looking for Mr. or Ms. Moneybags? Hunt down the perfect mate in these wealthy cities, which are brimming with unattached professionals. More
Fun festivals: Twins to mustard to pirates!
You'll see double in Twinsburg, Ohio, and Ketchup lovers should beware in Middleton, WI. Here's some of the best and strangest town festivals. Play
Index Last Change % Change
Dow 17,227.09 35.72 0.21%
Nasdaq 4,625.92 -12.07 -0.26%
S&P 500 2,000.74 -1.42 -0.07%
Treasuries 1.75 0.03 1.57%
Data as of 10:06am ET
Company Price Change % Change
Yahoo! Inc 42.30 -4.16 -8.95%
Facebook Inc 74.60 -1.64 -2.15%
Bank of America Corp... 15.32 0.12 0.79%
Apple Inc 116.29 0.98 0.85%
Microsoft Corp 41.15 -0.04 -0.10%
Data as of 9:53am ET

Sections

Royal Dutch Shell is cutting investment by $15 billion over three years, joining the ranks of energy companies who are being forced to adapt to the oil price collapse. More

The majority of public school students are poor, and many won't be prepared to enter the workforce in the future, experts say. More

Want a new TV for the Super Bowl? Some great deals make now the time to buy. More

On demand delivery startup WunWun is expecting its order volume to double by the time they close up shop on Monday. All thanks to a blizzard. More

401(k) balances reached a record high last year, thanks to a soaring stock market and larger contributions from workers participating in the savings plans, according to Fidelity. More

Most stock quote data provided by BATS. Market indices are shown in real time, except for the DJIA, which is delayed by two minutes. All times are ET. Disclaimer.

Morningstar: © 2015 Morningstar, Inc. All Rights Reserved.

Factset: FactSet Research Systems Inc. 2015. All rights reserved.

Chicago Mercantile Association: Certain market data is the property of Chicago Mercantile Exchange Inc. and its licensors. All rights reserved.

Dow Jones: The Dow Jones branded indices are proprietary to and are calculated, distributed and marketed by DJI Opco, a subsidiary of S&P Dow Jones Indices LLC and have been licensed for use to S&P Opco, LLC and CNN. Standard & Poor's and S&P are registered trademarks of Standard & Poor’s Financial Services LLC and Dow Jones is a registered trademark of Dow Jones Trademark Holdings LLC. All content of the Dow Jones branded indices © S&P Dow Jones Indices LLC 2015 and/or its affiliates.