The Patient Protection and Affordable Care Act's Provisions Regarding Medical Loss Ratios and Quality: Evidence from Texas

摘要

Objectives. The Patient Protection and Affordable Care Act (PPACA) includes a provision that penalizes insurance companies if their Medical Loss Ratio (MLR) falls below a specified threshold. The MLR is roughly measured as the ratio of health care expenses to premiums paid by enrollees. I investigate whether there is a relationship between MLRs and the quality of care provided by insurance companies. Methods. I employ a ten-year sample of market-level financial data and quality variables for Texas insurers, as well as relevant control variables, in regression analyses that utilize insurer and market fixed effects. Results. Of the 15 quality measures, only one has a statistically significant relationship with the MLR. For this measure, the relationship is negative. Conclusions. Although the MLR provision may provide incentives for insurance companies to lower premiums, this sample does not suggest that there is likely to be a beneficial effect on quality. ^g>Affordable Care Act, medical loss ratio, HEDIS.