Bloomberg Law
April 8, 2022, 9:30 AM

Insurers’ ‘Gaming’ of Obamacare Provision Seen Boosting Premiums

Sara Hansard
Sara Hansard

An Obamacare provision designed to protect consumers from price gouging in health insurance is instead being manipulated to keep premiums high, driving up the costs for individuals and employers alike.

That’s the consensus of federal agencies, academics, and employer groups familiar with the workings of the Affordable Care Act’s medical loss ratio provision, which requires insurers in the individual and group markets to spend at least 80% of their premium revenue on claims or quality improvement, or refund the difference.

They say health plans are avoiding making refunds or lowering premiums by giving unwarranted bonuses to medical providers, paying some ...

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