Feds Don't Exempt Texas From Health Reform 80% Rule

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Published 01/30/2012 - 6:36 a.m. CDT

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Dallasnews.com REPORTS HERE that "the federal government on Friday refused to let Texas ease a requirement that health insurers devote at least 80 percent of premium revenue to medical care."

"The new federal rule, which makes insurers falling short of the mark pay back the difference to consumers, will bring rebate checks on last year's premiums to thousands of Texans as early as August."

"Officials of the U.S. Department of Health and Human Services said Texas insurance regulators did not convincingly back up their claim that immediate enforcement of the medical-spending minimums would disrupt the state's "individual market." That's where about 750,000 Texans buy policies without any help from their employers."

Federal officials considered Texas' arguments and data, but said in a letter to state Insurance Commissioner Elizabeth Kitzman, "We conclude that the evidence presented does not establish a reasonable likelihood" the market will be destabilized.

"Last summer, the state Department of Insurance sought relief. It said requiring an 80-percent "medical loss ratio" – where insurers have to devote at least that much of premium dollars to medical care, or give back the difference -- was too drastic a change."

"Companies would flee and that would 'result in fewer choices for consumers,' argued former Commissioner Mike Geeslin, who was Kitzman's predecessor and -- like her, an appointee of Gov. Rick Perry."

"Geeslin applied for permission to let Texas insurers devote just 71 percent of individuals' premiums to care and quality improvements this year, 74 percent next year and 77 percent in 2013. In 2014, all state-regulated policies will have to meet the federally set marks."

"Federal officials, however, noted Friday that insurers covering at least 93 percent of the Texans covered by individual policies have said they won't leave the market or are at or close to the minimum-spending goal already."

"The rule is a key provision of the federal health care overhaul and is changing insurers' behavior, and not just in the individual market, said Gary Cohen, a federal official who oversees health insurance, told reporters."

"Although adjustments are allowed only for a state's individual market, the broader rule could benefit several million other Texans, whose employers do not self-insure but instead purchase policies regulated by the state. State officials have said they don't have reliable numbers but consumer groups say as many as five million people are in the state-regulated health insurance markets."

"To avoid rebates, insurers must spend at least 80 percent on medical care and quality improvements in the markets for individuals and small groups – 2 to 50 employees; and at least 85 percent in the large group market."

"Seventeen states sought adjustments to the rule in their individual markets. Of them, six states have been granted full or partial relief, Cohen said. Nine more, including Texas, were denied. Decisions on Wisconsin and North Carolina are pending, he said."

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