By Ronnie Polaneczky | Philadelphia Daily News

KYLER VANNOCKER died last weekend at Children's Hospital of Philadelphia, enveloped in so much love it seemed impossible its power wouldn't pull him through his latest medical crisis.

But Kyler's lungs, damaged by the treatment he'd received over the past three years for neuroblastoma, could no longer support his small body. By Sunday, it was clear to his parents, Paul and Maria, and to his extraordinary medical team at CHOP, that this was to be his final setback.

Calls were made, and loved ones made a surreal race, through Sunday's glorious sunshine, to Kyler's bedside in the ICU, to weep goodbyes.

Still, he hung on - sedated yet somehow aware - until Paul and Maria realized what he was waiting for.

Ever since his diagnosis, whenever Kyler got tired, he wouldn't allow himself to fall asleep unless his parents gave him the OK. Once they said, "It's all right, buddy, you can sleep," he felt safe enough to drift off.

So on Sunday, they repeated the ritual of comfort. They gently reassured Kyler it was OK to let go.

Last week the National Association of Insurance Commissioners issued proposed rules for measuring the Medical Loss Ratio (MLR), a key instrument for controlling health insurance premiums. The MLR is the 80-85% of premiums that the new health care reform law requires insurance companies to spend on medical care, or improvements to the quality of care, as opposed to administration. Companies that fail to meet that test must give subscribers a rebate. The usually out-gunned consumer representatives at the NAIC supported the state insurance commissioners' vote to adopt the proposed rules unanimously, claiming a victory against insurance industry lobbyists.

But a key provision that slipped through threatens both the effectiveness of the MLR, and the integrity of public health departments. The U.S. Department of Health and Human Services (HHS) is backing a late amendment that would allow insurance companies to count their collaborations with public health departments as quality improvements.

What this means: Partnerships between private, for-profit health insurance companies and cash-strapped public health departments would be counted as part of the expenditures of your premium dollars to improve your health.

The key question is this: Should insurance companies be able to get off the hook for paying rebates to customers, who may believe their company is unfairly denying them specific medical care in order to save money, by virtue of engaging in health promotion campaigns?

Even assuming you like the idea of entrusting health promotion campaigns to your health insurance company, is the MLR a remotely suitable mechanism for encouraging them to engage in these campaigns?

This is a classic mismatch of policy priorities. The MLR is meant to compel your insurance company to direct your premiums to pay for your health care. If your premium dollars are going to programs that benefit any non-subscriber. it shouldn't count against your right to a rebate. On the other hand, public health departments are meant to use your tax dollars to improve the health of your community. There are simply no grounds to divert public health department efforts to serve subscribers to a particular health plan.

There aren't a lot of these partnerships now -- at least not legitimate ones. Most often they take the form of marketing campaigns that happen to focus on public health issues such as smoking cessation. If this rule stands, we can likely look forward to increasing insurance industry incursions into public health territory. So what? At least 3 things: 1. Premium dollars will be further frittered away on marketing campaigns re-dubbed as "health awareness." 2. Real public health department initiatives, and funding for same, will be undermined as already scarce public health staff are diverted to determining whether particular insurance company campaigns are legitimate or not. 3. Smoking cessation campaigns, for example, can help insurance companies identify and then cherry-pick customers, either excluding smokers from coverage, or charging them more (the excess charges remain legal even after new rules take effect in 2014).

Interestingly, the insurance industry is also lobbying not to count investment income, or the taxes they pay on investment income, as, well, income, for purposes of calculating the MLR. Those are the taxes that they should be paying to support our state and local health departments.

HHS has to "certify" the NAIC's recommendations before they take effect. The EQUAL Health Network says this one should get a recall.

Background can be found here.

Link to Original Huffington Post Article

If there's one thing the National Association of Insurance Commissioners don't see much of, it's public attention. Now, however, it's got the attention of the media, consumer advocates and at least part of an increasingly aware public. The spotlight may lead them to better decisions, even though insurance company lobbying has not diminished a bit.

The NAIC is finishing up its first proposals for regulations that will bring health reform to life--the new health law's requirement that insurance companies spend from 80% to 85% of premium dollars on health care--and less than they spend now on overhead, profit and marketing. That greater efficiency, if it occurs, would help bring down the insurance premiums, or at least curb recent double-digit increases.

No one can tell whether the regulations will actually do that. The proposals so far give away a lot to insurers, allowing them to magically count a lot of former administrative duties as health care: even their "accreditations"--meaning a certification of financial health--get counted as health care in the latest proposal. But from what I hear, it could have been a lot worse, and the public openness of the process gets a lot of credit, along with steady pressure from consumer advocates both inside and outside the organization.

The commissioners will vote tomorrow on their first batch of regulatory proposals, and pass them along to the Department of Health and Human Services. If the votes have no surprises, sunshine gets credit for a small victory.

What the NAIC should do now, before these rules are set in stone, is to measure what they'll accomplish. Its actuaries should apply the new rules to the last three years of insurance company financial reports, and tell us if the giveaways are forcing the insurance companies to change anything at all.They don't have to wait until every proposal is approved--give us a running tally!

If a combination of new tax deductions and concessions on what "health care" means add up to even a 5% or even 3% shift in measuring the proportion spend on health care, the whole effort of birthing these regulations may mean nothing. But we'll never know unless someone with access to the information and the tools to measure the change gives us some answers.

We'll know more tomorrow about the what the proposed recommendations say, but we need hard data on what they'll actually do.

The big buzz today at a meeting of the National Association of Insurance Regulators was that President Obama would speak to the thousand-plus people gathered here--and then that he wouldn't. Maybe he didn't want to get involved in a down-to-the wire battle over whether insurance companies will have to grow more efficient and spend more of our premium dollars on health care--or just keep doing business as usual, with double-digit premium increases.

It ought to be obvious that when all Americans are required to show proof of health insurance, the largely for-profit companies that sell it shouldn't be free to do as they please--cutting their proportion of health spending and increasing profits to keep Wall Street happy. But it's far from settled.