HHS: One ACA provision saved Americans $4B last year

Under the health law, insurers must spend 80% of premiums on medical costs

Topics: Reimbursement, Finance, Access to Care, Quality, Performance Improvement

June 21, 2013

The medical-loss ratio provision in the Affordable Care Act (ACA) helped U.S. residents save about $3.9 billion through a combination of lower health insurance premiums and rebates in 2012, HHS Secretary Kathleen Sebelius announced Thursday.

Under the medical-loss ratio provision, private insurers must spend at least 80% in the individual market—or 85% in the group market—of premium dollars on direct medical costs. Insurers that do not comply with the ratio must issue rebates to consumers.

HHS said that the provision helped about 77.8 million U.S. residents save a total of $3.4 billion from lower premiums in 2012.

In addition, insurers will pay $500 million in rebates to employers and individuals after Aug. 1 for failing to comply with the provision. Specifically, HHS said rebates will go to 8.5 million enrollees, which will receive an average of $100 per family.

Last year, the rebates averaged about $150 per family. CMS Deputy Administrator Gary Cohen said insurers are paying fewer rebates in 2012 than in 2011 because they are more strictly adhering to the law and charging lower premiums up front.

Cohen said, "As [insurers have] adjusted their prices to the new rule, as they've become more efficient and more cost effective, two things happen: the number of rebates goes down and the corresponding amount of premium that people have to pay for the value they are getting for insurance comes down as well."

Cohen also noted that other provisions of the ACA have contributed to lower premium rates by increasing competition among carriers and encouraging insurers to operate more efficiently.

Sebelius touted the savings as an immediate benefit of the ACA and evidence that the law will make insurance coverage more affordable. Sebelius said, "The health care law is providing consumers value for their premium dollars and ensuring the money they pay every month to insurance companies goes toward patient care" (Baker, "Healthwatch," The Hill, 6/20; Humer, Reuters, 6/20; Schatz, Wall Street Journal, 6/20; Block, Modern Healthcare, 6/20 [subscription required]).

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