Insurance Commissioner Sixto K. Igisomar provided the media with the official Health and Human Services national press release on MLR, and additionally cautions the public on misinterpretations of Obamacare as it is politically known, or the common term of Affordable Care Act, “pee-Pahka” (PPACA), or “eHcera” (HCERA). These all mean one and the same.
The Patient Protection and Affordable Care Act or PPACA is the first act, followed by an amendment immediately thereafter under the Health Care Education and Reconciliation Act, or HCERA. As if the following acronyms are not enough, try adding the Public Health Service Act, or PHSA. For most people, especially those in the health insurance industry, these are clear and simple, but for most of us typical people in the street, we are easily misled by politics.
For the most part, the Obama Care (Obamacare) does not include territories. Most of the expansions were added or interpreted through Secretary Sebelius of HHS (Health and Human Services), via the PHSA, and only after representatives of territories-including Gov. Benigno R. Fitial-requested for inclusion in PPACA. As a result of Secretary Sebelius’ intervention, much of the Obamacare federal grant assistance now extends to the CNMI to respond to Early Market Reforms, Rate Reviews, Medical Loss Ratios, Medicaid, External Reviews, and so on. The complexity surrounding the question of whether territories are to be covered by the Obamacare is the fact that the definition of states does not include the territories. A memo from the Congressional Research Service dated April 19, 2010, to Kilili and et al, shows that any serious inquiry of the Obamacare expansion to the territories came after the fact, and not during or before the passage of PL 111-148 (PPACA) or PL 111-152 (HCERA).
This question is important, as it will show how much effort the Insurance Commissioner and the Administration is working hard to make sure that the Obamacare is expanded to the CNMI but with proper guidance. Supported by only 53,000 population along with a challenged economy, and an insurance division that is staffed with only one personnel due to austerity measures, the Obamacare expansion requires diligent review for careful implementation to balance resources and provide a fair and balance consumer/insurance relationship. The current administration’s outreach and dialogue with the Secretary Sebelius, Federal Regional Council – Region 9, and the Commissioner’s active involvement with National Association of Insurance Commissioners has brought about many improvements in closing the gap and allowing Obamacare to actually aide the CNMI community.
On the Medial Loss Ratio, or MLR, no one is to take credit for this, except for the hardworking HHS staff and NAIC special committees that work hard to provide proper guidance to state regulators and to insurance carriers. In addition, most especially to Territory Head of State’s for their efforts accepting the expansion based on Sebelius’ interpretation. For the CNMI, the MLR press, as officially released by HHS, is only for a specific carrier offering Individual Plans here in the CNMI. The MLR rebate, although released and mandated by the Obamacare, for the CNMI, the MLR rebate is only attributed to the same company that normally rebates to health insurance customers every year-with little more; we need not mention the carrier and leave the announcements and press to them.
Furthermore, it is important to clarify that not everyone is to get the rebate, and not everyone may get the average amount stated earlier from other press releases. The rebate under the MLR is not as easy as dividing the total value by number of insureds. There are other factors that are involved and carriers may release the amounts lower than reported. Most importantly, do not plan on receiving $782 dollars for this Christmas. Call your health insurance company and ask on whether you are affected and how will you be getting your rebate; through offsets or however, and how much would it be.
For more information, contact Commerce at 664-3077 or email email@example.com.
Angel A. Demapan
Office of the Governor