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Texans who buy their own health insurance could be due an estimated $481 million in refunds over the next three years, thanks to the Affordable Care Act (ACA), the much-maligned national health reform law. Unfortunately, some Texas officials are trying to deny consumers the money they are owed – and hand most of it right back to the insurance companies. Learn more about this issue at Moneyfall co uk.
At issue is a pro-consumer provision in the ACA designed to keep insurance companies from gouging policyholders. This rule – known as the medical loss ratio (MLR) – makes sure insurance companies don’t spend more than 20 percent of customers’ premiums on non-health care items like marketing, CEO salaries, paperwork and profits. Spend any more, and the company must cut consumers rebate checks.
This rule gives insurers ample room to turn a profit while providing an incentive for them to keep unnecessary costs down. But under the state’s proposal to phase in the rule, consumer refunds would be cut by more than half, a loss of more than $200 million for consumers over the next three years.
The Texas Department of Insurance (TDI) argued that unless the MLR requirement is weakened, some insurers will withdraw from Texas, leaving residents with fewer choices. Yet the state’s fear is overstated. Texas has more than 30 insurers offering plans to consumers who buy their own coverage. That contrasts sharply with Maine, for example, which was granted an adjustment because one of just three insurers serving its individual market threatened to pull out if the requirement went into full effect in 2011.
In Texas, insurers representing more than 90 percent of the market have stated they do not intend to exit if required to increase value in their health plans.
Texas residents need strong market competition to keep health insurance costs down and service up. And the new MLR requirement provides a level playing field for that competition. But consumers don’t need an infinite number of health insurance choices if they are of poor value.
Texans work hard and deserve a fair value for their health-insurance dollar. And they deserve state insurance officials who balance their interests along with those of local insurance companies. At a time when families are tightening their belts, insurance companies should be required to do the same.
Federal officials are currently reviewing the state’s proposal and should reject Texas’ attempt to maintain business-as-usual for low-value health insurers.
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