Wendell Potter is a former health insurance company executive, and he knows exactly how health insurance companies maximize profits at the expense of policyholders. Now Wendell is putting his inside knowledge of the industry to work -- for policyholders. On Saturday, August 14, he addressed the National Association of Insurance Commissioners (NAIC) at their summer meeting in Seattle, Washington. NAIC is charged with writing regulations to implement the new health insurance reform law, the Patient Protection and Affordable Care Act. The big issues right now are the minimum medical loss ratio (MLR) requirements in the law, which set the minimum amount of policyholder funds insurance companies must put towards subscribers' medical care. The law contains a pro-consumer provision that requires insurance companies put 80 percent of their policyholders' funds towards medical care for individual and small group plans. The figure is 85 percent for issuers of large group coverage. Wendell told the NAIC that the insurance industry will evade this requirement by manipulating figures to show improved earnings and enhanced shareholder profits. He said the NAIC can stop the industry's actions to circumvent the law by keeping the definition of what constitutes a "medical cost" very narrow. "You are the ultimate consumer representatives," Wendell told NAIC members, adding that the group has a choice: It can either serve "as a champion for consumers, or as a champion for health insurance carriers."
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