Which most Americans aren't in. And you might want to watch this closely. The ACA redefines what "Medical Loss Ratio" means. Note that "premium dollars on health care and quality improvement." The "quality improvement" bucket is going to see a lot of cash. Historically, MLR was determined to be the percentage of healthcare premiums collected that were actually spent on healthcare. Now insurance companies have this nice, big, fat bucket to put excess monies collected into. This is a sham. They're giving us a jelly bean while the Wall Street backed insurance carriers continue to get caviar. But, we'll call it "fish eggs" from now on so the Sheeple will think we've stuck it to the fat cats.

The Medical Loss Ratio provision of the ACA requires most insurance companies that cover individuals and small businesses to spend at least 80% of their premium income on health care claims and quality improvement, leaving the remaining 20% for administration, marketing, and profit. The MLR threshold is higher for large group plans, which must spend at least 85 percent of premium dollars on health care and quality improvement...Traditionally, MLR is defined as the portion of premium income insurers pay out in the form of health care claims (claims divided by premiums). But under the ACA, insurers can make adjustments for quality improvement activities and expenditures on taxes, licensing and regulatory fees.

So, what's in this new bucket of values we add to the numerator?

Quality Improvement: To be included in this category, health improvement activities must lead to measurable improvements in patient outcomes or patient safety, prevent hospital readmissions, promote wellness, or enhance health information technology in a way that improves quality, transparency, or outcomes. Provider credentialing is also included as a health care improvement activity under the ACA. However, insurance broker and agent compensation is not considered an expense relating to health improvement under current law, and is therefore counted as an administrative expense in the ACA MLR. The same is true for fraud prevention activities.

Taxes, Licensing and Regulatory Fees: Includes federal taxes and assessments, state and local taxes, and regulatory licenses and fees. Taxes on investment income and capital gains are not included. Not-for-profit insurers, which are subject to different tax requirements by state, may either deduct state premium taxes or community benefit expenditures (up to a maximum of the highest state premium tax in their state), whichever is greater.

http://www.kff.org/h...m/upload/8282.pdf

Who does the measuring of "measurable improvements in patient outcomes or patient safety?" Well, the private insurer does, of course. And they're honest. Really. Oh, and isn't that nice. Another tax break for Wall Street firms. Splendid.