Writing New Rules for Insurers

To the Editor: In his Perspective article, Jost (Nov. 11 issue) 1 discusses the medical loss ratio — the percentage of an insurer's premium revenue that it spends on clinical services for enrollees. In assessing the medical loss ratio, medical expenses must be defined narrowly to effectively provide incentives for cost control and ensure that premiums intended to pay for medical care are not diverted into marketing, administration, and excessive executive compensation. Current proposals give the insurance industry two enormous new bites into the apple. The new health care reform law (the Affordable Care Act [ACA]) includes “activities that improve health . . .