What ObamaCare Regulation Will Mean for the Individual Market

The introduction of a minimum MLR regulation [see previous post here] as part of the PPACA has the potential to significantly affect the functioning of the individual market. Our results suggest that in 9 states, at least 50% of actively operating health insurers would likely fail to meet the 80% minimum MLR. Furthermore, we observed that in 12 states, at least one-half of total member-years of enrollment were affiliated with health insurers failing to meet the minimum MLR using the PPACA-adjusted definition.

To the extent that insurers with low MLRs opt for terminating product lines or exiting the market completely, consumers could experience some coverage disruption. Individual market enrollees who are medically uninsurable due to a recent diagnosis and/or high claims experience may be particularly vulnerable.

Full study by Jean Abraham and Pinar Karaca-Mandic available here.

Comments (5)

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  1. Mike J. says:

    Let me get this straight – ObamaCare is destroying the market? This is universal coverage??

  2. Alfie K. Rotwile says:

    Ok look, I’m tired of all this doomsday “healthcare-will-not-survive-ObamaCare nonsense.” It can’t be true. Why would legislators pass a bill that ends up hurting the people they were elected to serve?

  3. Leo Matel says:

    Yeah Alfie, because the government would NEVER make a mistake…

  4. Devon Herrick says:

    All the evidence I’ve seen suggests the individual market will have a hard time surviving under the new regulations. For one thing, money spent on fraudulent and wasteful medical care is included in the medical component of the MLR. Yet, funds spend to reduce waste and fraud is considered administration, the total of which cannot exceed 20% of premium dollars.

  5. Stephen C. says:

    Alfie, are you serious? Surely not.