Sunday, September 12, 2010

New health law keeps TN insurance commissioner engaged

Leslie A. Newman can barely recall an idle moment during her days as the state's insurance commissioner — a tenure that will end when Gov. Phil Bredesen leaves office in January.
Lately, Newman has been working with commissioners from other states on guidelines for implementing provisions of the federal health-care overhaul signed into law this spring.

There also have been renewed questions about her department's oversight after a rash of scams involving sellers of bogus health insurance and pitches to businesses on plans with below-market health premiums that weren't enough to cover claims.

Newman, a lawyer by training, spoke with health-care business writer Getahn Ward about the role of states in implementing health-care reform and the recent crackdown on bogus health insurance.

What are the key responsibilities states have in health-care reform?

Insurance is still almost exclusively regulated at the state level, including health insurance, so the states will have a major responsibility as various reform requirements kick in between now and 2014.

The federal law recognizes the importance and the success of state-based insurance regulations by delegating to the NAIC (National Association of Insurance Commissioners) a major role in developing guidelines and definitions for what is called medical loss ratios. So we have been participating along with all the other states in that process. The carriers and consumer groups are very concerned about the medical loss ratio piece.

What emerged from discussions on medical loss ratios at last month's NAIC summer meetings in Seattle?

Medical loss ratio is pretty complex. What it essentially does is dictate how much of every premium dollar must go to pay for health-care costs versus administrative overhead.

We came up with a form that carriers will have to fill out that will provide information on how they spend those premium dollars — and then the instructions that go along with that form that provide definitions of some things like quality improvement.

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