One of the issues with PPACA is that it requires insurance companies to expend 85% of the money it takes in on patient care. Specifically,
• Require health plans to report the proportion of premium dollars spent on clinical services, quality,
and other costs and provide rebates to consumers for the amount of the premium spent on clinical
services and quality that is less than 85% for plans in the large group market and 80% for plans in the
individual and small group markets. (Requirement to report medical loss ratio effective plan year 2010;
requirement to provide rebates effective January 1, 2011)
• Establish a process for reviewing increases in health plan premiums and require plans to justify
increases. Require states to report on trends in premium increases and recommend whether certain
plan should be excluded from the Exchange based on unjustified premium increases. Provide grants to
states to support efforts to review and approve premium increases. (Effective beginning plan year 2010)