McCue Michael J, Hall Mark A
Department of Health Administration, School of Allied Health Professions, Virginia Commonwealth University.
Issue Brief (Commonw Fund). 2015 Mar;6:1-11.
For the past three years, the Affordable Care Act has required health insurers to pay out a minimum percentage of premiums in medical claims or quality improvement expenses--known as a medical loss ratio (MLR). Insurers with MLRs below the minimum must rebate the difference to consumers. This issue brief finds that total rebates for 2013 were $325 million, less than one-third the amount paid out in 2011, indicating much greater compliance with the MLR rule. Insurers' spending on quality improvement remained low, at less than 1 percent of premiums. Insurers' administrative and sales costs, such as brokers' fees, and profit margins have reduced slightly but remain fairly steady. In the first three years under this regulation, total consumer benefits related to the medical loss ratio--both rebates and reduced overhead--amounted to over $5 billion. This was achieved without a great exodus of insurers from the market.
在过去三年里，《平价医疗法案》要求健康保险公司在医疗理赔或质量改进费用方面支付最低比例的保费，这一比例被称为医疗损失率（MLR）。医疗损失率低于最低标准的保险公司必须将差额返还给消费者。本问题简报发现，2013年的总返还金额为3.25亿美元，不到2011年支付金额的三分之一，这表明保险公司对医疗损失率规则的遵守程度大大提高。保险公司在质量改进方面的支出仍然很低，不到保费的1%。保险公司的行政和销售成本，如经纪费和利润率略有下降，但仍相当稳定。在该法规实施的头三年里，与医疗损失率相关的消费者总受益——包括返还金额和减少的间接费用——超过了50亿美元。这一成果的实现并未导致大量保险公司退出市场。
