Florida Seeks Relief from Healthcare Reform Provision

One of the requirements of the national healthcare reform law is that health insurers must spend at least 80% of their premiums on delivering healthcare services.  The current requirements (so called “medical loss ratios”) are 65% for traditional insurers and 70% for HMOs.  Earlier this month, state Insurance Commissioner Kevin McCarty requested US HHHS Secretary Kathleen Sebelius to delay the provision of the healthcare reform law that requires health insurers to spend 80% of their premiums on providing healthcare services.  If granted, the delay would allow insurers to meet the 60% and 70% established levels.  The reason for Commissioner McCarty’s request:  belief that the 80% requirement would decimate the health insurance market in Florida.

It is well known that Governor Scott campaigned against the healthcare reform law.  Similar requests for waivers can be expected around the country, as well as legal challenges to the law’s constitutionality.  Interestingly, there has been no delay in the state’s desire to curtail physician and hospital expenditures and their primary move in that direction, the quasi privatization of the state Medicaid program and introduction of a competitive bid process.  Though most will feel the squeeze, there is clear opportunity for those physicians and other healthcare business people willing to assume more economic and clinical risk.

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