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“I am very disappointed that the narrowly divided vote of Insurance Commissioners elevated politics over the sound, evidence-based decision making that is expected of us as insurance regulators,” said Commissioner Jones after the close vote.
He said consumers are ill-served by the proposal to lower the percentage of premiums that insurers are now required to put into medical care versus profits and overhead.
“The specific resolution in question was never heard by a NAIC committee, nor was there a public hearing on the resolution,” he said. “It was first circulated secretly to only some commissioners as opposed to all of us. The lack of transparency, the failure to follow a process that would include committee review and a public hearing, the willful disregard of the evidence – all undermine the credibility of the NAIC's vote today.”
During a holiday week, without any opportunity for the public to be heard, the NAIC narrowly voted to support a resolution that calls on the federal Department of Health and Human Services to take action it lacks the authority to take and for the Congress to make changes to the federal law that would increase the cost of health insurance.
The resolution calls on Congress to weaken one of the most important consumer protection provisions in the Affordable Care Act – the medical loss ratio (MLR) requirement that 80 percent of every premium dollar go into providing health care in the individual and small group markets and 85 percent in the large group market.
Jones and 19 other insurance regulators from around the country voted against the resolution and five Commissioners abstained.
Earlier this year, the NAIC took a look at agent and broker commissions and the medical loss ratio provisions of the Affordable Care Act.
The Health Committee of the NAIC (the B Committee) issued a report that indicates:
“In 2011, a significant number of companies have reduced commission levels, particularly in the individual market. However, a significant number of companies have not reduced commissions in 2011.”
“The states with higher MLR requirements have not observed any problems with consumer access to insurance or to producers.”
“… adjusting the MLR calculations for producer compensation, results in an increase in the MLR by several percentage points.”
If agent and broker commissions had been removed from the MLR calculation in 2010, consumer rebates would have been reduced by more than 60%, from $1.95 billion down to $762 million.
The net result of the proposal would be to reduce consumer rebates by more than $1.1 billion. At the same time, the experience of states that had higher MLRs is that consumers still have access to agents and brokers.
Jones opposed the resolution because it would reduce rebates to consumers, increase the cost of health insurance to consumers and reduce their access to health care and on process grounds because the NAIC did not vet this resolution through any NAIC committee nor did it allow the public the opportunity to comment on the resolution prior to today's vote.
Jones pointed out that “I have been contacted by consumer organizations and thousands of individuals who have asked me to vote against this resolution. This resolution calls for actions that would allow insurers to spend more money on administrative costs and profits, while charging consumers higher premiums.”
Jones continued, “I recognize the important role that licensed health agents in my state play in assisting consumers and I will work with them to help ensure that they continue to play such a role as our nation's health care system changes and expands to cover tens of millions of additional policyholders, but rolling back the MLR requirement is not the answer. There is no guarantee that the health agents and brokers would benefit from this proposal, but the evidence shows that consumers would be harmed.”
A data call conducted by the California Department of Insurance earlier this year demonstrated that commissions paid to health insurance agents/brokers increased over 300 percent between 2003 and 2010, as commissions increased along with skyrocketing health insurance premiums.
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No illnesses have been associated with the recalled product.
Symptoms of E. coli O157:H7 infection may include abdominal cramps and diarrhea which is often bloody.
Most infected people recover within a week; however, some may develop complications that require hospitalization.
Young children and the elderly are at highest risk for a potentially life-threatening complication known as hemolytic uremic syndrome (HUS) which includes kidney failure.
The voluntarily recalled romaine lettuce is packaged in 9 oz., 9.25 oz., 10 oz., 10.25 oz., and 16 oz. bags under the Ready Pac, Trader Joe’s, Safeway and Dining In Classic labels. Products have a use by date of Nov. 18, 2011.
The recall was issued based on a positive finding of E.coli O157:H7 from a random surveillance sample of bagged lettuce collected and analyzed by the United States Department of Agriculture. The recalled romaine products were distributed to retail locations in Arizona, California, Colorado, Hawaii, Idaho, Oregon, Texas and Washington.
Consumers should discard the product or return them to the place of purchase.
People who develop symptoms of E. coli O157:H7 infection after consuming Ready Pac romaine lettuce should consult their health care provider.
Consumers that observe the product being offered for sale are encouraged to report their findings to the CDPH toll free complaint line at 800-495-3232.
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“Individuals suffering from mental illnesses have long faced disparity in the coverage they receive from their insurers, and the time is now to end this practice,” Commissioner Jones said. “The Mental Health Parity Act was created to ensure that people affected by mental illnesses receive the coverage they need, and insurers have an obligation to abide by this critical law.”
A panel of the U.S. Court of Appeals for the Ninth Circuit held several months ago that the California Mental Health Parity Act required Blue Shield of California to provide residential care treatment for a woman suffering from anorexia nervosa.
Blue Shield denied coverage on the ground its health plans exclude coverage for residential care treatment.
The panel held that denying coverage on that ground deprived a patient of critical services needed to treat a mental illness.
The panel found that the Mental Health Parity Act creates both a mandate (all insurers must cover listed mental illnesses) and a requirement of parity (an insurer must provide that coverage on terms no more restrictive than for physical illnesses).
Commissioner Jones strongly supports the panel’s analysis.
The panel’s decision is important not just for people suffering from anorexia nervosa. It applies to many other serious mental illnesses, including bipolar disorder, major depressive disorders, and pervasive developmental disorder or autism.
The commissioner has been particularly concerned about insurers’ denial of coverage to children in need of autism treatment. The panel decision upholds their rights.
The Commissioner’s brief comes in the context of Blue Shield’s request to the full Ninth Circuit Court that it set aside the panel’s decision. The commissioner urges the court to keep the panel decision on the books. See the brief below.
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Consumers in possession of the candy should discard it immediately, Chapman reported.
Recent analysis of this candy by CDPH determined that Roopal Swad candy contained as much as 0.18 parts per million (ppm) of lead.
California considers candies with lead levels in excess of 0.10 ppm to be contaminated.
Roopal Swad candy is imported and distributed by India Imports & Exports Inc. in Los Angeles, which initiated the voluntary recall.
CDPH is currently working with the distributor to ensure that the contaminated candies are removed from the market place.
Sold in a 7-ounce (200 gram) clear plastic package, the candy is visible through the package and wrapped in silver foil with a dark brown design. The package label is yellow with the brand name “Roopal” at the top in a red oval. The words “Swad Candy” appear in the middle of the package.
Pregnant women and parents of children who may have eaten this candy should consult their physician or health care provider to determine if medical testing is needed. Information, including photos, is available on the CDPH Web site at the Roopal Swad Candy Imported From India Due to High Levels of Lead page.
Consumers who find this candy for sale should call the CDPH Complaint Hotline at 1-800-495-3232.
For more information about lead poisoning, contact your county childhood lead poisoning prevention program or public health department. Additional information is available on the CDPH Childhood Lead Poisoning Prevention page.
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