Monk-Eye
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- Feb 3, 2018
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" Affordable Care Act Medical Loss Ratio Does Not Limit Premiums Or Profits "
* Taking Advantage Of Premiums Subsidized By Government *
Subsidized by us government , were medical insurance companies able to raise premiums , to raise costs of treatment and to purchase medical equipment , beyond normal expectations in the health care and health insurance industries , because MLR requirement in ACA does not limit profits or premiums and only requires that 80% or 85% of premiums be spent on health care treatment or improvements ?
A medical loss ratio (MLR) is the percentage of health insurance premiums an insurer spends on medical claims and quality improvement. The Affordable Care Act (ACA) requires insurers to have an MLR of at least 80% for individual and small group markets and 85% for large group markets, or they must provide rebates to enrollees.
* No Mention Of MLR In *
In the free market , corporations negotiate cost schedules for treatments and premiums with insurance companies , so giving money to individual taxpayers is nonsense , as individual taxpayers do not have the leverage to bargain for lower pricing .
. Understanding the ACA Subsidy Discussion | Committee for a Responsible Federal Budget .
Policymakers could reduce the cost of the enhanced subsidies by incorporating reform proposals to scale back the size of the enhancement, strengthen the means testing, and/or lower the underlying cost of ACA subsidies – including by directly funding cost-sharing reductions (CSRs) to reduce a practice known as "silver-loading."
. The ACA's Cost-Sharing Reductions (CSRs): A Primer | Committee for a Responsible Federal Budget .
Cost-sharing reductions (CSRs) are payments made directly to insurers to lower costs for low-income individuals who purchase silver plans, which cover 70 percent of expected health care costs (actuarial value, or AV). Specifically, they allow individuals with incomes below 250 percent of the federal poverty level to purchase silver plans on the ACA exchanges that have a higher AV – 73, 87, or 94 percent instead of 70 percent – with the CSRs going directly to insurers to defray the extra cost.
www.cms.gov
The Centers for Medicare & Medicaid Services (CMS) is finalizing a major rule that will lower individual health insurance premiums by approximately 5% on average. It is also projected to save taxpayers up to $12 billion in 2026 by combating the surge of improper enrollments in the Affordable Care Act (ACA) Exchanges, reining in wasteful federal spending, and refocusing on making health insurance markets more affordable and sustainable for hardworking American families. The 2025 Marketplace Integrity and Affordability Final Rule restores oversight, strengthens accountability, and ensures taxpayer dollars are used only for those who are truly eligible.
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Improper ACA enrollments, enabled by weakened verification processes and expanded premium subsidies, have triggered widespread fraud. Research shows that in 2024 alone, an estimated 5 million people may have been improperly enrolled, costing taxpayers as much as $20 billion[1].
Prohibiting federal subsidies from being used to help cover the cost of specified sex-trait modification procedures to align an individual’s physical appearance or body with an asserted identity that differs from the individual’s sex; and
Reinstating HHS’ longstanding 2012 interpretation of “lawfully present” to exclude Deferred Action for Childhood Arrivals (DACA) recipients from eligibility and enrollment in ACA Exchange coverage and Basic Health Program (BHP) coverage in States that elect to operate a BHP, including APTC, premium tax credits, and cost-sharing reductions.
* Taking Advantage Of Premiums Subsidized By Government *
Subsidized by us government , were medical insurance companies able to raise premiums , to raise costs of treatment and to purchase medical equipment , beyond normal expectations in the health care and health insurance industries , because MLR requirement in ACA does not limit profits or premiums and only requires that 80% or 85% of premiums be spent on health care treatment or improvements ?
A medical loss ratio (MLR) is the percentage of health insurance premiums an insurer spends on medical claims and quality improvement. The Affordable Care Act (ACA) requires insurers to have an MLR of at least 80% for individual and small group markets and 85% for large group markets, or they must provide rebates to enrollees.
* No Mention Of MLR In *
In the free market , corporations negotiate cost schedules for treatments and premiums with insurance companies , so giving money to individual taxpayers is nonsense , as individual taxpayers do not have the leverage to bargain for lower pricing .
. Understanding the ACA Subsidy Discussion | Committee for a Responsible Federal Budget .
Policymakers could reduce the cost of the enhanced subsidies by incorporating reform proposals to scale back the size of the enhancement, strengthen the means testing, and/or lower the underlying cost of ACA subsidies – including by directly funding cost-sharing reductions (CSRs) to reduce a practice known as "silver-loading."
. The ACA's Cost-Sharing Reductions (CSRs): A Primer | Committee for a Responsible Federal Budget .
Cost-sharing reductions (CSRs) are payments made directly to insurers to lower costs for low-income individuals who purchase silver plans, which cover 70 percent of expected health care costs (actuarial value, or AV). Specifically, they allow individuals with incomes below 250 percent of the federal poverty level to purchase silver plans on the ACA exchanges that have a higher AV – 73, 87, or 94 percent instead of 70 percent – with the CSRs going directly to insurers to defray the extra cost.
CMS Finalizes Major Rule to Lower Individual Health Insurance Premiums for Americans | CMS
Rule Cracks Down on Improper ACA Enrollments, Protects Patient and Taxpayer Dollars, and Restores Marketplace Integrity
...
Improper ACA enrollments, enabled by weakened verification processes and expanded premium subsidies, have triggered widespread fraud. Research shows that in 2024 alone, an estimated 5 million people may have been improperly enrolled, costing taxpayers as much as $20 billion[1].
Prohibiting federal subsidies from being used to help cover the cost of specified sex-trait modification procedures to align an individual’s physical appearance or body with an asserted identity that differs from the individual’s sex; and
Reinstating HHS’ longstanding 2012 interpretation of “lawfully present” to exclude Deferred Action for Childhood Arrivals (DACA) recipients from eligibility and enrollment in ACA Exchange coverage and Basic Health Program (BHP) coverage in States that elect to operate a BHP, including APTC, premium tax credits, and cost-sharing reductions.
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