The ACA Does Require an 80 Percent Medical Loss Ratio

September 18, 2013

This point would have been worth including in a NYT piece that reported on how the state of Florida appeared to be undercutting provisions of the Affordable Care Act (ACA) that were designed to curtail abuses by insurers. The ACA requires insurers to make benefit payments that are at least equal to 80 percent of its premiums, unless they have been given an explicit exemption from this provision.

This provision is enforced by the Department of Health and Human Services. It should limit the extent of insurer abuses even if a state is determined to look the other way.

Thanks to Robert Salzberg for calling this to my attention.

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