The Obama administration on Thursday denied Wisconsin's request for a waiver from the healthcare law's medical loss ratio, while partially approving North Carolina's.
With the two decisions, the Department of Health and Human Services has concluded its review of the 17 states that have requested a waiver from the law's requirement that individual market insurance plans spend at least 80 percent of premiums on medical care or give customers rebates.
Wisconsin wanted a lower ratio of 71 percent in 2011, 74 percent in 2012 and 77 percent in 2013. HHS determined that most of its carriers were already at the 80 percent threshold or on the way there.
"We have determined that the evidence presented does not establish a reasonable likelihood that the application of an 80 percent MLR standard will destabilize Wisconsin’s individual market," Steve Larsen, the director of the agency charged with implementing the healthcare law's insurance overhaul, wrote in a letter to Wisconsin Insurance Commissioner Theodore Nickel. "Consequently, we have determined not to adjust the MLR standard in Wisconsin’s individual market and, thereby, ensure that consumers receive the benefit of this provision of the Affordable Care Act."
For its part, North Carolina had requested an adjustment of 72 percent, 74 percent and 76 percent for reporting years 2011, 2012 and 2013, respectively. HHS found that the state's insurance market was highly concentrated — Blue Cross Blue Shield has an 81 percent market share — and that imposing a full 80 percent MLR on smaller carriers could make it impossible for them to compete.
"Therefore," HHS said in a fact sheet, "HHS determined to grant an alternative adjustment of 75 percent for 2011 only, with the 80 percent standard to apply in 2012 and 2013 in order to ensure market choice is preserved. This approach, which creates a glide path for compliance with the 80 percent standard, balances the interests of consumers, the State and the issuers in accordance with the principles underlying the MLR provision."
The rejected states were: North Dakota, Delaware, Texas, Kansas, Oklahoma, Florida, Indiana, Louisiana, Michigan and Wisconsin. The states that were allowed to meet a lower MLR threshold are Maine, New Hampshire, Kentucky, Nevada, Iowa, Georgia and North Carolina.
Guam also applied for a waiver, but HHS said the MLR provision didn't apply because its insurance market is too small.