STILL the most important sentence in the House HC Bill

by Bruce Webb

Much of the criticism about the House Health Care Bill coming from the left revolves around the ‘fact’ that it has no meaningful premium and so profit controls. Moreover most of those same people are promoting HR676 as an alternative. Frankly those people simply haven’t read either bill with attention to detail. And this includes a lot of people sporting the title ‘Dr.’

In both cases the key language comes right up front. In HR3962 it is as follows:

(a) GROUP HEALTH INSURANCE COVERAGE.—Title XXVII of the Public Health Service Act is amended by inserting after section 2713 the following new section:
‘‘(a) IN GENERAL.—Each health insurance issuer that offers health insurance coverage in the small or large group market shall provide that for any plan year in which the coverage has a medical loss ratio below a level specified by the Secretary (but not less than 85 percent), the issuer shall provide in a manner specified by the Secretary for rebates to enrollees of the amount by which the issuer’s medical loss ratio is less than the level so specified.

That final sentence simply guts the insurance companies current business which involves widening the spread between premium dollars collected and medical care actually provided. This sentence sets a hard limit on raising premiums while managing the risk pool to exclude those actually being likely to make claims. The tighter you manage your enrollment the harder it is to actually hit your mandated MLR, and every time you raise premiums you have to demonstrate that you have increased payouts to that same degree. Or else you have to rebate the difference.

In the original House Tri-Committee Bill this language was included in Sec. 116 and a site search on that term will pull up a series of posts on this dating back to July. And I have diaried on this elsewhere, yet somehow almost everyone has simply missed the significance of this. Or maybe I have overstated the case. If so explain it to me in comments. I will post a parallel post on the paragraphs that show HR676 to be a ridiculous piece of legislation, a case of a wolfish socialization program hidden in a Medicare for All sheep’s clothing, but for the moment I don’t want to distract from this key provision.