When I moved back to Texas in 2003, I had to find new health insurance. It seemed that the company I had been using in Philadelphia didn't underwrite insurance in Texas. I contacted an agent, and he steered me towards Blue Cross Blue Shield of Texas. I applied and was accepted.
Because I'm a self-employed scholar, I wasn't eligible for a group plan. So I had to go with an individual plan with a deductible of $2500. Over the years the cost of this not-very-good policy has risen by roughly 150%. At my current premium of $312 a month, I'm now paying $3744 a year for my coverage.
Because I had health insurance, however mediocre, I never figured that the Affordable Care Act would make much of a difference to me. Turns out that I was wrong about that.
A few days ago I got a surprising letter from BCBSTX. Here are the important excerpts:
The Affordable Care Act requires Blue Cross and Blue Shield of Texas (BCBSTX) to issue a rebate to you if BCBSTX does not spend at least 80 percent of the premiums it receives on health care services, such as doctors and hospital bills, and activities to improve health care quality, such as efforts to improve patient safety. No more than 20 percent of premiums may be spent on administrative costs such as salaries, sales, and advertising. This requirement is referred to as the "Medical Loss Ratio" standard or the "80/20 rule". The 80/20 rule in the Affordable Care Act is intended to ensure that consumers get value for their health care dollars.
[. . .]The Medical Loss Ratio rule is calculated on a State by State basis. In Texas, BCBSTX did not meet the Medical Loss Ratio standard. In 2011, BCBSTX spent only 71.0% of a total of $1,054,029,473 in premium dollars on health care and activities to improve health care quality. Since it missed the 80 percent target by 9.0% of premiums it received, BCBSTX must rebate 9.0% of your health insurance premiums.
[. . .]We are issuing a credit to the bank account you used to pay your premium. Your credit is $357.56.
Color me surprised. I guess that some BCBSTX executive gets one less expensive dinner in a fancy Dallas restaurant.
I must have heard about this aspect of the Affordable Care Act at some point, but I can't remember anything about it. Since this would have been a major selling point for people like me who already had health insurance, I have to wonder how hard it was pressed when the bill was winding through Congress.
Did the Obama administration simply not talk this up very much? I really can't remember. But if you can, please let me know. Go to my "about me" page to get my email address.
And if you google "medical loss ratio" for yourself, you'll get lots of hits.