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We Won! HHS Denies Texas Waiver Request on 80-20 Rule

The U.S. Health and Human Services (HHS) agency is going to protect better health, not bottom lines, and you are the one who made it happen!

In December, 2,775 of you joined us and Texas Well and Healthy to sign a petition demanding HHS deny the Texas Department of Insurance’s waiver request about the new medical loss ratio (MLR) "80-20 Rule." As we have previously written, under the Affordable Care Act, 80% of a company’s health care dollars are required to go towards health care rather than overhead.

The state of Texas did not want to follow this common sense rule, but today we learned that Katleen Sebelius at Health and Human Services is going to protect this essential piece of the Affordable Care Act. A summary of the U.S. Health and Human Services agency decision can be read here, and the full 14-page decision can be read here. From the decision:

Sixteen Texas State Representatives submitted two identical letters requesting denial of the Department's application, suggesting that "consumers will pay a steep price" and that there will be "an average loss of $350" for each Texans if an adjustment to the MLR standard is granted...A petition signed by 2,775 individuals voices identical concerns.


A little bit more on this important ruling from The Hill:

HHS determined that almost all of the insurers in Texas's individual market either already meet the 80 percent threshold or have said they don't plan to leave the state once it's imposed.

Texas had asked HHS to apply a 74 percent medical loss ratio this year, followed by 77 percent next year. All plans in all states must be at 80 percent in 2014. Plans that fall short of the spending requirements will have to pay rebates to their customers.

We want to thank you and the fair minded Texas state and federal legislators who followed your efforts and spoke out about protecting better health, not bottom lines, for Texas. We hope you will keep working with us to defend the Affordable Care Act in Texas and ensure that better care, not bottom lines, is at the forefront of each and every health care decision we make in our great state.

Finally, go here to watch HHS Secretary Kathleen Sebelius talking more about the Affordable Care Act earlier this week, on the Daily Show.