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The medical loss ratio: a core component of reform.

The Affordable Care Act (ACA) was intended to achieve two main goals: reduce the cost of health care and lead to better health outcomes for the country. Insurance reform is a critical component of both endeavors. As we move through 2014, the most noticeable aspects of insurance reform are quite visible, such as the end of pre-existing condition exclusions, the individual mandate, minimum standards for what policies must cover, and implementation of insurance exchanges. Behind all that there is a far more important aspect of insurance reform: mandated medical loss ratio (MLRs) or, as the White House commonly refers to it “the 80-20 rule.” It has not received as much attention by the public, but has far more impact on how health care reform moves forward. Physician leaders will want to understand the MLR and the arguments made by its proponents and opponents. This one, small section of the ACA has enormous implications and encapsulates much of the debate over the ACA in its entirety. It may surprise many in health care to learn that everything we do to prevent disease, cure the sick and improve the health of our patients is considered a “loss,” but that is the reality from the insurance perspective, as money spent on patients cannot be invested in administrative costs (such as salaries, overhead, and marketing) or returned to investors as profits. At the end of the day, everything of which we are proud in medicine — delivering safe, efficient and patient-centered care — is a loss.