Don’t get me wrong. I still remained firmly committed to Universal, single payer health care for all Americans, administered like Medicare, but organized around pay for result, not pay for service. That said, not everything about the PPACA (usually noted as the ACA) is bad. One of the law’s best features takes effect on the first of next month. When the bill passed, the naysayers accused that the final regulations on this item would be tailored to fit the needs of Big Insurance. The naysayers were wrong.

Aaaaand, the fuse has been lit. Insurers are not happy. Not even a little bit. What they feared most about the Affordable Care Act — more than insuring people with pre-existing conditions, more than leaving children on their parents’ policies until age 26, more than having to lift lifetime caps, more than any of those things — was the limited Medical Loss Ratio (MLR).

The PPACA limits the "padding" between actual claims paid and premium collections to 15% for large groups and 20% for individuals and small groups. Any excess the insurer has must be refunded to insureds by the end of the year for which the MLR is determined. Everyone scoffed at the time over these limits, figuring the regulations would be broad and wide enough for insurers to run through the loopholes.

But no. Final rules were issued last week and insurers didn’t get anything they wanted. Via Rick Ungar [propaganda delinked] at Forbes:

This is the true ‘bomb’ contained in Obamacare and the one item that will have more impact on the future of how medical care is paid for in this country than anything we’ve seen in quite some time. Indeed, it is this aspect of the law that represents the true ‘death panel’ found in Obamacare—but not one that is going to lead to the death of American consumers. Rather, the medical loss ratio will, ultimately, lead to the death of large parts of the private, for-profit health insurance industry.

Why? Because there is absolutely no way for-profit health insurers are going to be able to learn how to get by and still make a profit while being forced to spend at least 80 percent of their receipts providing their customers with the coverage for which they paid. If they could, we likely would never have seen the extraordinary efforts made by these companies to avoid paying benefits to their customers at the very moment they need it the most.

Ungar’s logic at the end is a little bit wrong. The current MLR, just for perspective, is about 40-45%. That means for every dollar paid toward health coverage, only 60 cents or so goes to actual health costs. The rest is considered overhead — agents’ commissions, big CEO salaries, and of course, that shareholder profit that benefits those with the money to actually buy shares in these companies. Medicare, on the other hand, has a very low overhead attached to it — about 7-8%, because it is in the business of providing medical benefits, and not making a profit or paying CEOs handsome salaries.