Provide names of other journalists involved.
(None)
List date(s) this work was published or aired.
March 23, 2011.
Provide a brief synopsis of the story or stories, including any significant findings.
A key consumer protection provision in the Affordable Care Act is the “medical loss ratio” requirement, under which individual and small business health insurance plans must spend at least 80% of premiums on medical claims or measures to improve health care quality. Insurers that do not meet the standard must refund the difference beginning Aug. 1, 2012. But there have been unintended consequences. A year after the ACA was enacted, many states asked for waivers from the provision, fearing their individual insurance markets would be destabilized and consumers would lose coverage if insurers left their markets. In addition, insurers began cutting commissions to health insurance agents and brokers to lower administrative expenses to meet the requirement, which is threatening their livelihood. Many believe small businesses and individual consumers will need agents and brokers to help them choose health plans as coverage is increased under the health care reform law. But consumer representatives say attempts to remove brokerage commissions from the formula will weaken the provision’s protections.
Explain types of documents, data or Internet resources used. Were FOI or public records act requests required? How did this affect the work?
Internet source: the website for the Centers for Medicare & Medicaid Services’ Center for Consumer Information and Insurance Oversight, part of the Department of Health & Human Services (http://cciio.cms.gov/). Citi Investment Research & Analysis report on Florida’s Minimum MLR Waiver (http://op.bna.com/hl.nsf/r?Open=shad-8f2rbp). Letter to National Association of Insurance Commissioners’ Professional Health Insurance Advisors Task Force opposing legislation to remove brokers’ commissions from the MLR (http://op.bna.com/hl.nsf/r?Open=shad-8f3kdt).
Explain types of human sources used.
State insurance commissioners, state insurance department health policy analyst, Citi Investment Research analyst, health insurance agent, health insurance actuary, consumer representative to the organization that represents state insurance commissioners, health insurance brokerage association congressional affairs vice president, executive director of association for individual and small group insurers, health care policy consultants, comments from primary health insurance association CEO and HHS official in charge of insurance regulation at national conference, comments from HHS official in charge of insurance regulation at House of Representatives hearing, health care research organization president, pharmacy benefit management company government affairs official.
Results:
I was able to get insight into what impact state insurance commissioners, both Democratic and Republican, believe the requirement will have on their insurance markets. I also was able to add financial analysis about the impact of removing the requirement. I was able to include the perspective of consumer representatives. The story included first-hand information about the impact of the MLR on agents and brokers, as well as on individual and small group health insurance plans. I also was able to represent the views and concerns of the primary association that represents health insurers, and the position of the administration in defending the requirement.
Follow-up (if any). Have you run a correction or clarification on the report or has anyone come forward to challenge its accuracy? If so, please explain.
No.
Advice to other journalists planning a similar story or project.
Get information from all sides of the issue, including financial analysis on the impact of the rule on both consumers as well as on the industry.