by Patrick Appel
Currently there is no federally imposed minimum on the percentage of premium dollars that insurers must spend on health care, a statistic known as a "medical loss ratio." States typically require only 55 percent to 60 percent. The House bill requires 80 percent. Reid modified that to 80 percent for family policies and 75 percent for individual policies, then bumped it up to 90 percent to compensate for the loss of a public option. The manager's amendment now sets it at 85 percent for large-employer-based policies and 80 percent in the nongroup and small-business markets. According to a little-noticed Dec. 13 CBO analysis, setting the medical loss ratio any higher would have compelled CBO to consider private insurers to be part of the federal government!