Victory for Texas Consumers

Today the U.S. Department of Health and Human Services (HHS) denied the Texas Department of Insurance's (TDI) request to delay implementation of an important piece of the Affordable Care Act. The "medical loss ratio (MLR)" rule requires insurance companies to spend at least 80% of insurance premiums on actual health care services, and 20% on overhead costs for individual health insurance plans. In July, TDI asked to delay implementation of the "medical loss ratio" rule claiming that implementation would "destabilize" the individual health insurance market in Texas. In December, I along with members of the House Democratic Caucus, sent a letter in opposition to TDI's request that would have resulted in the return of $260 million to insurance companies instead of to the pockets of everyday Texans who buy their own health insurance. I applaud HHS for their decision and thank them for enforcing this crucial piece of the Affordable Care Act in order to make quality, affordable health care a closer reality for Texas families.


Below are some clips that further explain the MLR rule:

The Texas Tribune: Feds Reject Texas' Request to Delay Insurance Reform
by Becca Aaronson
The U.S. Department of Health and Human Services has rejected the Texas Department of Insurance's proposal to delay implementation of a federal health care reform provision aimed at curbing rising premiums.

The Dallas Morning News: Federal Officials Reject Texas' Plea to Slash Health Insurance Rebates to Consumers
by Robert T. Garrett
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.

Memorandum on Medical Loss Ratio Adjustments
by Stacey Pogue, Center for Public Policy Priorities
Under the Patient Protection and Affordable Care Act (ACA), health insurers must spend a reasonable share of premium dollars on medical care and quality improvement efforts, as opposed to administration, marketing, and profits. These standards, known as medical loss ratio (MLR) requirements, hold insurers accountable for how they use consumers' premium dollars.