WASHINGTON, D.C., June 12, 2013 – The Independent Insurance Agents & Brokers of America (IIABA or the Big “I”) today expressed its support for bipartisan legislation, the “Access to Professional Health Insurance Advisors Act,’’ sponsored by Rep. Mike Rogers (R-Mich.) and Rep. John Barrow (D-Ga.). The bill would clarify that agent compensation is not part of the Medical Loss Ratios (MLRs) formula as enacted in the health care overhaul law.

 

The Patient Protection and Affordable Care Act (PPACA) established MLR requirements for insurance carriers that went into effect on Jan. 1, 2011. The law mandates that at least 80% (individual and small group) or 85% (large group) of premiums collected by the carrier must be spent on claims payments and “health care quality improvement.” These restrictions mean no more than 20% or 15% may go towards “non-claims costs” such as profits, advertising, administrative costs, etc. If a carrier does not meet these ratios, they must issues rebates to the consumer. 

 

The law did not statutorily address how to classify independent agent compensation under the MLR formula. Unfortunately, although agent compensation does not go toward insurers’ bottom lines, through the regulatory process agent compensation was included as a part of the “non-claims costs” category. The Rogers-Barrow legislation corrects this issue by specifically excluding agent compensation from the MLR formula.

 

“Since going into effect more than two years ago, the MLR regulations have had a detrimental impact on agents and brokers,” says Charles E. Symington, Big “I” senior vice president for external and government affairs. “The legislative fix in the bill authorized by Reps. Rogers and Barrow would clarify that agent compensation is not an insurance company administrative expense, thereby providing much needed relief to health agents and brokers across the country.”

 

The impact of the MLR rules on agents and brokers has been damaging as many insurance carriers have significantly cut their agent compensation in an effort to comply with the regulations. In turn, this has reduced consumer access to agents and brokers, leading to a detrimental effect on essential services provided such as guidance in claims processing and tailoring health plans to fit the needs of individuals and businesses.

 

“The Big ’I’ is grateful to Reps. Rogers and Barrow for introducing this critical legislation again this Congress,” says Ryan Young, Big “I” senior director of federal government affairs. “Enactment of this bill would go a long way toward ensuring that the professional, licensed guidance of insurance agents remains available to consumers during this time of great change in the health insurance market.”