Medical Loss Ratio rebate checks look good, but he 80/20 rule is actually driving healthcare costs up. If insurers are limited to making 20 percent of what they spend on their subscribers, they’re going to be consciously or unconsciously motivated to spend more.
BIDEN ADMINISTRATION SHOULD
RESCIND THE 80/20 RULE. IT DOES HARM
On the heels of the Biden
Administration issuing its interim
final rule related to the No Suprises
Act, I am urging the federal
government to take further action to
drive down healthcare costs.
The Administration should
consider rescinding the
80/20 Rule, also known as
the Medical Loss Ratio.
The company I founded, TALON,
already has clients in 49 states
who have turned to the company
to achieve compliance with both
the No Surprises Act and
Transparency in Coverage Rule.
app and related software
products were viewed as gold
standards by the government
as the Rule and Act were
Because it is clear the 80/20
Rule actually incentivizes
insurers to waste subscriber
In simple terms, the 80/20 Rule
means that insurers must spend
80 percent of their revenue from
premiums to pay for the
healthcare of their subscribers.
Americans have received
rebate checks from their
health insurers when the
Medical Loss Ratio doesn't
"measure up" to the 80/20
Rebate checks look good, but when
Minnesota's former Senator Al
Franken championed them as part of
the Affordable Care Act, he didn't
think about how the 80/20 rule would
affect the psychology of health
The truly good news about the Biden
Administration issuing its interim final rule
related to the No Surprises Act and the prior
issuing by the Trump Administration of the
Transparency in Coverage Rule should be
accompanied by the President rescinding the
80/20 Rule by Executive Order.
The Biden Administration
would only further those
goals by surgically removing
the cancerous 80/20 Rule.
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