A state insurance decision out of Massachusetts is potentially very informative for how implementation of healthcare reform initiatives will play out. Strong nationwide debate is underway regarding the authorization to regulate health plan rates and medical loss ratios pursuant to the Patient Protection and Affordable Care Act. Small group insurance rate regulation has played a significant role in that debate and gave rise to the controversy addressed in the June 24 decision by the appeals board in the Massachusetts Division of Insurance. The appeals board focused on provider market power as a driver of increasing costs and found the health plan’s efforts to contain provider costs and utilization reasonable, along the road to deciding that the plan’s proposed small group rate increases were not unreasonable. As healthcare reform moves forward, similar issues may well arise in other states or in reviews undertaken by federal regulators and the Massachusetts decision could prove to be an important precedent.
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