Health Aff (Millwood). 2013 Sep;32(9):1546-51. doi: 10.1377/hlthaff.2012.1316.
The Affordable Care Act's regulation of medical loss ratios requires health insurers to use at least 80-85 percent of the premiums they collect for direct medical expenses (care delivery) or for efforts to improve the quality of care. To gauge this rule's effect on insurers' financial performance, we measured changes between 2010 and 2011 in key financial ratios reflecting insurers' operating profits, administrative costs, and medical claims. We found that the largest changes occurred in the individual market, where for-profit insurers reduced their median administrative cost ratio and operating margin by more than two percentage points each, resulting in a seven-percentage-point increase in their median medical loss ratio. Financial ratios changed much less for insurers in the small- and large-group markets.
平价医疗法案对医疗费用赔付率的规定要求健康保险公司将所收取的保费至少 80%-85%用于直接医疗费用（医疗服务提供）或用于提高医疗服务质量的努力。为了评估该规定对保险公司财务业绩的影响，我们衡量了 2010 年至 2011 年期间反映保险公司营业利润、管理费用和医疗理赔的关键财务比率的变化。我们发现，最大的变化发生在个人市场，营利性保险公司将其管理费用比率和营业利润率中位数降低了两个以上百分点，导致其医疗费用赔付率中位数增加了七个百分点。小型和大型团体市场的保险公司的财务比率变化要小得多。
