The simple concept at the root of Question 2

Also: Why advocates say Mass. needs a thousand more school counselors [View in browser](    [❤️]( October 18, 2022 Hi CommonHealth reader, Medical loss ratio. It’s a bit of an intimidating term — medical jargon that can induce a glazed-over look. The good news is it’s a pretty simple concept. And it's worth getting familiar with, since it’s the subject of Question 2 on ballots this fall in Massachusetts. And, if successful, proponents hope it could reshape how dental insurers across the country spend your money. Here's the CliffsNotes version of what to know about this insider term, and why it matters. The concept Every month, many people pay for dental insurance, but only a portion of that money goes to actual patient care, like fillings or fluoride varnishes or root canals. The rest of the money stays with the insurance company and goes to things like administrative costs and executive salaries. The term medical loss ratio refers to the portion of premium dollars spent on patient care and initiatives to improve its quality. For health insurance companies, the Affordable Care Act set a minimum medical loss ratio of 80% (in Massachusetts it's 85%-88%). If it passes, Question 2 would introduce the same concept to the dental industry in Massachusetts. It would set the minimum that dental insurers must spend on patient care at 83% of premium dollars. If the dental insurers spend less on patient care, they would need to offer rebates to the people they insure. The debate: dentists vs. insurers The "Yes on 2" campaign is backed by dentists. They argue that this type of system is necessary to ensure good value for customers and accountability for insurers. The campaign’s spokesperson told me that right now, it's unclear how much insurers spend on dental care because that data isn’t public. (Part of this ballot question would require financial disclosures from insurers.) Meanwhile, the "No on 2" campaign is backed by dental insurers. They counter that this measure will lead to price increases. Plus, it could trigger some insurers to leave the state and some employers to change the dental coverage they offer. Ultimately, they say, residents will pay more for dental care, and some people could lose their dental insurance. The experts I spoke to don’t envision dramatic changes. But they do say prices might go up a little. “It's not clear that this ballot initiative was ever designed really to solve a problem for patients,” said Evan Horowitz at Tufts University, who did [an analysis of the ballot question](. “It's designed to intervene in an ongoing dispute between insurers and dentists about where the money — in the world of dental insurance, the world of dental care — goes.” The big picture No other state has this type of broad threshold for dental insurers. Thus, all the talk about what precedent Question 2 could set — if it passes. But it’s important to remember that this is not a new idea. In addition to the health insurance industry, one expert pointed out that this system does exist for certain dental insurance products. In particular, some types of Medicaid dental insurance – in places like Nevada, Florida and California – have established medical loss ratios. So, that's the short version. 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