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Congresswoman Michelle Lujan Grisham

Representing the 1st District of New Mexico

Lujan Grisham Introduces Legislation to Hold Health Insurance Companies Accountable

Mar 17, 2017
Press Release

WASHINGTON, D.C. – Congresswoman Michelle Lujan Grisham introduced legislation today to hold health insurance companies accountable for returning premiums not used for medical care to patients. 

Under the Affordable Care Act, companies must spend at least 80-85 percent of premiums on a patient’s medical claims and activities. If companies spend less than 80-85 percent, they must issue the difference to their customers as a rebate. However, the law does not include stringent oversight by the Department of Health and Human Services to ensure companies are spending adequately on medical care, and if not, returning money to patients.

“Patients deserve to know whether they are getting what they pay for,” Rep. Lujan Grisham said. “Expecting health insurance companies to self-report the money they are spending on patient care puts too much faith on an industry known for putting profits ahead of people. We need to be doing more to hold these companies accountable.”

Rep. Lujan Grisham’s legislation would require federal audits of a representative sample of insurance companies’ “medical loss ratios,” which determine the refunds those companies are required to return to patients.