《平价医疗法案》与医疗损失率：头三年无影响

THE AFFORDABLE CARE ACT AND MEDICAL LOSS RATIOS: NO IMPACT IN FIRST THREE YEARS.

作者信息

Day Benjamin, Himmelstein David U, Broder Michael, Woolhandler Steffie

出版信息

Int J Health Serv. 2015;45(1):127-31. doi: 10.2190/HS.45.1.i.

DOI:10.2190/HS.45.1.i

Abstract

The Patient Protection and Affordable Care Act (ACA) set limits on insurers' overhead, mandating a medical loss ratio (MLR) of at least 80 percent in the individual and small-group markets and 85 percent in the large-group market starting in 2011. In implementing the law, the Obama administration introduced new rules that changed (and inflated) how insurers calculate MLRs, distorting time trends. We used insurers' filings with the U.S. Securities and Exchange Commission to calculate the largest insurers' MLRs before and after the ACA regulations took effect, using a constant definition of MLR. MLRs averaged 83.04 percent in the three years before reform and 83.05 percent in the three years after reform. We conclude that the ACA had no impact on insurance industry overhead spending.

摘要

《患者保护与平价医疗法案》（ACA）对保险公司的管理费用设定了限制，规定自2011年起，个人和小团体市场的医疗损失率（MLR）至少为80%，大团体市场为85%。在实施该法律时，奥巴马政府引入了新规则，改变（并夸大了）保险公司计算MLR的方式，扭曲了时间趋势。我们利用保险公司向美国证券交易委员会提交的文件，采用恒定的MLR定义，计算了ACA法规生效前后最大保险公司的MLR。改革前三年的MLR平均为83.04%，改革后三年为83.05%。我们得出结论，ACA对保险业的管理费用支出没有影响。