Local insurance companies were in compliance with fed ACA
Congressman Faleomavaega Eni's office says American Samoa insurance companies did comply with provisions of the federal Affordable Care Act (ACA) and for this reason, local residents did not receive rebates.
Residents of Guam, did however receive rebates thanks to the ACA, as their insurance companies were not in compliance.
The ACA is often referred to as "Obamacare".
U.S. Department of Health and Human Services Secretary Kathleen Sebelius announced last week that 49,160 Guam residents will benefit from $2.04 million in rebates from insurance companies this summer, averaging $2,615 per family, thanks to the Affordable Care Act.
Created under the ACA, the Medical Loss Ratio standard (also known as the “80/20 rule”) requires insurers to spend at least 80 cents of every premium dollar on patient care and quality improvement, according to a statement from the federal agency.
If they spend an excessive amount on profits and red tape, they owe rebates back for the difference, no later than August 1, 2013.
“This new standard is increasing transparency and accountability, promoting better business practices and competition among insurance companies, and ensuring consumers receive value for their premium dollars,” said Sebelius in the news release.
Responding to Samoa News questions, Faleomavaega’s office staff acknowledged that American Samoa and the Commonwealth of the Northern Mariana Islands were not mentioned in the DHHS news release regarding the insurance rebates.
His staff says the rebates are not “federal funding” but instead they are penalties for insurance companies who do not comply with an 80/20 rule.
“The money comes from the insurance company, not from the government,” Faleomavaega’s office says.
“The reason why we didn’t get any rebates is because insurance companies in American Samoa did meet the 80/20 requirement and therefore were not obligated to pay a rebate,” his office states.
“Technically this is good news for us because it means that constituents who do have private health insurance got a better deal on their insurance up front. And the rebates are good news for those who did receive them in other states because it means that the ACA is protecting families from being overcharged.”
“The goal of this program is that eventually all insurance companies will comply with the 80/20 rule and no rebates will be necessary in the future,” his office added.
According to DHHS, insurance companies that do not meet the standard cited in the federal law will send consumers a notice informing them of the rule. The notice will also let consumers know how much the insurer did or did not spend on patient care or quality improvement, and how much of that difference will be returned as a rebate.
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