U.S. Senator Mary L. Landrieu, D-La., chair of the Senate Committee on Small Business and Entrepreneurship, and Sen. Johnny Isakson, R-Ga., have introduced S. 2068, the Access to Independent Health Insurance Advisors Act, a companion bill and a shot in the arm for a medical loss ratio bill in the House that has many supporters but has gained no traction.
This legislation addresses that provision of the Affordable Care Act (ACA) known as the medical loss ratio (MLR) that many feel has squeezed the livelihood of agents and brokers by excluding their commissions from the healthcare, quality and care portion of the ratio.
The MLR rule, which went into effect on Jan. 1, 2011, mandates that at least 80% (individual and small group) or 85% (large group) of premiums collected by the carrier must be spent on "health care quality improvement."
The law, as written by Congress, did not statutorily address how to classify independent agent compensation under the MLR formula. However, through the regulatory process, the Department of Health and Human Services (HHS) ruled that not only was agent compensation included in the MLR formula but it was included as a part of the "non-claims costs" category, the agents community pointed out.
The Landrieu-Isakson legislation specifically excludes agent compensation from the MLR formula in the individual and small group markets. Reps. Mike Rogers, R-Mich., and John Barrow, D-Ga., have introduced similar legislation in the House of Representatives (H.R. 1206, the "Access to Professional Health Insurance Advisors Act of 2011"), which currently has 160 bipartisan co-sponsors but which has not hit the House floor.
Due to the Department of Health and Human Services' (HHS) interpretation of the MLR provisions in the health reform law, health insurance carriers are required to treat agent and broker commissions as part of their administrative costs.
S. 2068 makes some slight modifications to H.R. 1206 based on the MLR experience over the past year, as the National Association of Health Underwriters (NAHU) pointed out. Representatives Rogers and Barrow support these changes, NAHU said.
They include limiting the MLR exclusion to the individual and small-group health insurance markets, where the problem is most severe; clarifying that any bonuses agents may receive remain a carrier administrative expense; and striking language expanding the state MLR adjustments, as the majority of states that applied have already received their determination from HHS. Under S. 2068, the waiver process will remain as is.
