Health Roundup: Medical loss ratio expected today

The health policy world is anticipating a major regulatory announcement Monday morning when Health and Human Services Secretary Kathleen Sebelius makes a “major Affordable Care Act announcement” at the Kaiser Family Foundation.

Almost everyone is expecting HHS to unveil medical-loss ratio definitions, which spell out how insurance plans can account for healthcare spending as they try to meet the reform law's mandate to spend at least 80 or 85 percent of premiums on care. The National Association of Insurance Commissioners adopted their definitions last month and HHS, which the law says must “certify” their work, is not expected to depart substantially from their recommendations.

A few things to look out for:

  • How will HHS treat taxes? (The NAIC allows insurers to deduct most taxes when calculating the MLR but Democratic committee chairmen have told Sebelius that their legislative intent was to only deduce healthcare taxes, which would make it harder to attain the 80 or 85 percent target)
  • Will HHS allow greater flexibility when counting agent and broker fees and fraud prevention investments?
  • How much “credit” will insurers get if their plans have too little sales volume to be statistically credible? (NAIC has proposed a 14 percentage point credit.)
  • Will large plans be allowed to aggregate their ratios at the national level?
  • How will so-called mini-med plans be treated?

Even after HHS adopts its definitions, a number of  issues will remain unresolved. For example, the NAIC has asked federal regulators to create a phase-in period for the MLR.

Med students warned about reform law: Sens. John Barrasso (R-Wyo.) and Tom Coburn (R-Okla.), both doctors, have written an open letter to the nation's medical students warning them about the new healthcare reform law.

The open letter, circulated through the Association of American Medical Colleges, warns of "sweeping health care legislation" that will "significantly change the doctor-patient relationship."

"The health care law increases Washington’s role by creating more than 150 boards and entities invested with new powers that will inevitably intrude on the patient-physician relationship," the letter reads. "The new law also encourages 'cookbook medicine' with new comparative effectiveness authorities that will make coverage determinations based on cost — rather than what may be best for individual patients. Another similar new entity is an Independent Payment Advisory Board — a panel of unelected, unaccountable bureaucrats who are empowered to administer top-down reimbursement cuts designed to reduce federal health care spending."

The open letter is a response to similar outreach to medical students from the Department of Health and Human Services, which asked the association in September to circulate a letter outlining the benefits of the new law.

Primary-care docs, hospitals weigh in on ACOs: Four groups representing 350,000 primary care doctors have unveiled 21 principles for building Accountable Care Organizations and facilitating payments. ACOs, which are encouraged by the healthcare reform law, are care delivery models that put the patient at the middle of a web of health services instead of treating each visit to a different specialist separately. The principles are based on the premise that primary care “should be the foundation of any ACO.”

Separately, the Federation of American Hospitals is taking issue with draft criteria for ACOs released by the National Committee for Quality Assurance, a non-profit organization that accredits and certifies a wide range of healthcare organizations. The FAH in a letter to NCQA President Margaret O'Kane complains that the criteria are “both burdensome and overly prescriptive.”

NCQA draft criteria:

FAH's response:

Rep.-elect Harris under fire for healthcare comments: The liberal group Americans United for Change starts running radio and Facebook ads this week challenging Rep.-elect Andy Harris (R-Md.) to opt out of his government-provided healthcare or stop trying to repeal the law. The “Drop it or Stop it” ads come after Harris, an anesthesiologist, complained about having to wait a month for his coverage as a member of Congress to kick in. Other Republicans can also expect to be targeted in the future.

Radio ad:

Facebook ad:

Miller says mine-safety notices not enough: Rep. George Miller (D-Calif.) re-issued calls for passage of his stalled mine-safety bill after federal regulators put 13 mines on notice for patterns of safety or health violations.

“I applaud (the Mine and Safety and Health Administration's) aggressive enforcement action today against 13 mine operators who have repeatedly violated federal safety requirements,” Miller said in a statement. “Despite MSHA’s administrative actions taken today, these notifications are merely warnings to improve. Unfortunately, without legislative reforms, such as those contained in the Robert C. Byrd Miner Safety and Health Act of 2010 (HR 5663), MSHA must jump through far too many legal hoops to compel timely improvements and ensure lasting changes to unsafe mine operations.”

The bill would allow MSHA to place mines on a pattern of violation based on citations instead of requiring final adjudicated orders. It also mandates sustained high safety performance over a 12-month period, instead of allowing mines to sustain improvements over a much shorter 90-day period.