title: Insurers' responses to regulation of medical loss ratios.
abstract: The Affordable Care Act's medical loss ratio (MLR) rule requires health insurers to pay out at least 80 percent of premiums for medical claims and quality improve­ment, as opposed to administrative costs and profits. This issue brief examines whether insurers have reduced administrative costs and profit margins in response to the new MLR rule. In 2011, the first year under the rule, insurers reduced administrative costs nation­ally, with the greatest decrease--over $785 million--occurring in the large-group market. Small-group and individual markets decreased their administrative costs by about $200 million each. In the individual market, insurers passed these savings on to consumers by reducing their profits even more than administrative costs. But in the large- and small-group markets, lower administrative costs were offset by increased profits of a similar amount. Stronger measures may be needed if consumers are to benefit from reduced over­head costs in the group insurance markets.
authors.affiliation: Department of Health Administration, School of Allied Health Professions, Virginia Commonwealth University, USA. mccue@vcu.edu
authors.forename: Michael J
authors.initials: MJ
authors.lastname: McCue
authors.forename: Mark A
authors.initials: MA
authors.lastname: Hall
mesh_terms: D017046:Cost Savings / Q000191:economics*; D005544:Forecasting; D033161:Government Regulation; D019981:Health Care Sector / Q000191:economics / Q000331:legislation & jurisprudence / Q000639:trends; D006801:Humans; D007348:Insurance, Health / Q000191:economics* / Q000331:legislation & jurisprudence / Q000639:trends; D058991:Patient Protection and Affordable Care Act / Q000191:economics*; D013219:State Government; D014481:United States