I wish I could say that health care reform passed and we can just pick up and move on to the next issue, but it’s just not that simple. Although you’re not hearing about health reform on the evening news and the front page of your local paper much anymore, things haven’t slowed down a bit. So keep those sleeves rolled up and read on to learn how you can still be involved.

Many of the major reforms don’t take place until 2014 but there are a number of important provisions going into effect right now and over the next few months. The health reform law directs agencies like Health and Human Services to make the text of legislation a reality through creating definitions and procedures that were left undefined in the bill.

For example, we know that insurance companies will have to justify rate increases or potentially be disqualified from participating in the new state exchanges, but what makes for a justified rate increase? We know that the reform law requires insurers to spend at least 80% of premium dollars on care and quality improvement but what exactly constitutes quality improvement?

Here are three areas where you can comment right now and make your voice heard on implementing health reform. Just follow the links to insert your comments. Remember that your comments will be part of the federal register so leave out any personally identifiable information.

Premium Rate Review

Section 2794 of the new health care reform law requires health insurance companies to submit justification for an unreasonable premium increase. If an insurance company wants to raise your rates by 39% like WellPoint tried to do in California, then they’ll have to explain that increase before it can go into effect. Furthermore, they’ll have to put that information up on a website, instead of in a file cabinet hidden away from public view, and if insurers issue unjustified rates they can be barred from selling coverage in the new state exchanges.

Submit comments by clicking on this link. Feel free to use all or part of our suggestions.

Our thoughts:
• 90 Days Notices: Insurance companies should be required to file rate increases at least 90 days in advance and to alert policy holders of the proposed increase. This will provide ample time for the state to review increases and for the public to comment.
• Strong State Review: States must have the authority to deem rates unjustified based on factors like how many people will be forced out of an insurance plan if a rate increase goes into affect or how much that company is stockpiling in the bank and paying their executives.
• Someone on our Side: We need a consumer representative on the review board in every state. That’s someone that isn’t tied to the insurance industry and puts consumer interests first. A consumer representative should let us know if they see rate increases as unjustified.

Medical Loss Ratios

Starting next year, all insurers that offer large group policies will have to spend at least 85% of your premium on health care and in the individual or small group market, they must spend at least 80% of your premium on care. If they don't spend it on medical care, they will have to rebate you the difference. Up until now, medical loss ratio minimums have been largely unregulated in the marketplace. Only 13 states have laws that require insurers to spend a certain percentage of your premiums on medical care.

So this new law will help ensure that most of your premium will actually go toward medical care, rather than company profits or marketing. Here’s the catch: we need to make sure that insurance companies don’t try to game the system and just relabel their “administrative” costs as “medical” costs. This is a critical issue and key to increasing the value of your health care dollars.

Submit comments by clicking on this link. Feel free to use our suggestions.

Our thoughts:
• Measurable Outcomes: Insurers may not classify as “quality improvement” expenses for which there is little or no evidence that the activities improve outcomes. If the program doesn’t provide a measureable benefit to health care quality then it should be counted as an administrative expense.
• Quality Improvement not Cost-Control: If a program is primarily designed to reduce costs to the insurance company then it should not be defined as “quality improvement.” “Utilization review” nurses and other administrators whose job it is to review and often deny physician-recommended treatments should be included in administrative expenses, not as your “care”.
• Insurers should be incentivized to group the most profitable and least profitable plans together to achieve the medical loss ratio standards set forth in the health care reform law.

Web Portal

The web portal envisioned by the health care reform law serves two important functions: easing consumer shopping by displaying current health insurance options “side-by-side,” and providing a testing platform for the exchanges that will come online in 2014. This is our opportunity to let regulators know exactly what we want the new insurance marketplace to look like, what types of information we need, and how we should be involved in the development process.

Submit comments by clicking on this link. Feel free to use our suggestions.
Our thoughts:
• Provider Networks: One of the most important deciding factors in choosing health insurance for consumers is whether or not their current primary care physician is covered in the network. Consumers should be able to limit searches for available insurance plans based on doctor networks.
• Quality Ratings: In addition to disclosing important plan specifics like premium rates and out-of-pocket expenses, consumers want quality measures to help them choose a plan such as whether or not a plan is “good” or “recommended.”
• User Reviews: Like many websites such as Yelp that allow consumers to provide comments at the point of use, the new web portal should give users the ability to provide feedback on how the web portal can be improved over time.
• Live Assistance: Consumers should have access to live assistance to help answer questions while navigating the new web portal. This could be done through a toll free number or live chat function with a counselor.

I can say with absolutely certainty that insurance companies are actively trying to influence the implementation process as we speak, and looking at their track record it’s hard to believe they have consumer interests in mind. Take a minute and submit your own comments so the consumer voice is heard in Washington DC.

We’ll continue to send out opportunities for you to get involved as we implement the health care reform bill.

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