Citizen Portal
Sign In

Advocates and insurers clash over bill to raise insurers' medical-loss ratio to 90%

House Health Care and Wellness Committee · January 21, 2026
AI-Generated Content: All content on this page was generated by AI to highlight key points from the meeting. For complete details and context, we recommend watching the full video. so we can fix them.

Summary

House Bill 2283 would raise the medical-loss ratio to 90% for fully insured plans starting in 2027; patient groups and small-business advocates backed the change as a way to lower premiums, while major carriers warned it could destabilize markets and reduce consumer-facing services.

Representative Alicia Ruhl, prime sponsor of House Bill 2283, described the Patient Premium Value Act as a measure to ensure a greater share of premium dollars go to direct patient care rather than administration or profit, arguing tighter medical-loss ratios will improve affordability and reduce out-of-pocket costs.

Kim Weidner, committee staff, summarized the bill and the current federal MLR framework under the Affordable Care Act: federal rules set MLR minimums at 80% for individual/small group plans and 85% for large-group plans. HB 2283 would establish a 90% floor for fully insured individual, small-group and large-group plans issued or renewed on or after Jan. 1, 2027, and authorizes the insurance commissioner to adopt implementing rules.

Proponents included small-business owners, patient groups and physicians. Patrick Connor of NFIB and patient advocates said insurers sit on large unrestricted surpluses and that tighter MLRs could translate to lower premiums, higher provider reimbursements or rebates to consumers. Emily Bryce of Northwest Health Law Advocates cited rising premiums in the individual market and Massachusetts’ higher MLR precedent as evidence the measure can deliver rebates and savings.

Large carriers and plan associations opposed the bill as drafted. Marissa Engles (Association of Washington Healthcare Plans), Andrea Davis (Coordinated Care), Carrie Tellesen (Regence BlueShield) and Christine Brewer (Premera Blue Cross) warned a rigid 90% floor could reduce insurers’ ability to manage volatility, limit investments in consumer services (interpreters, nurse advice lines, technology) and prompt carriers to exit some markets, which could reduce plan choice and increase premium volatility.

Jane Beyer of the Office of the Insurance Commissioner told the committee the OIC is working with the sponsor on amendments to improve oversight and to address ways insurers might alter MLR calculations (for example, through payments to vertically integrated provider groups). The OIC noted states may set higher MLR standards under federal law but flagged practical and enforcement questions the committee should consider.

Witnesses urged a range of fixes and monitoring approaches; the transcript records ongoing amendment work between sponsors and the OIC. No final committee vote on HB 2283 is recorded in the public-testimony portion of the hearing.

Next steps indicated by witnesses and staff included further work on amendment language, OIC engagement on auditability and potential effects on market participation.