NU Online News Service, Dec. 7, 3:38 p.m. EST

House Republicans today sought to put new pressure on the Department of Health and Human Services over the medical loss ratio issue.

In a letter to commissioners, the Republicans imply that HHS put inappropriate pressure on the National Association of Insurance Commissioners in 2010 to get regulators to include agent commissions in the MLR calculations.

The letter also implies that HHS and NAIC officials might be forced to make written sworn testimony on the issue at public hearings.

It follows HHS' final regulation on Dec. 2, which includes agents' commissions in the MLR calculations despite an NAIC resolution adopted the prior week asking HHS to exempt such commissions.

The letter was signed by Reps. Fred Upton, R-Mich; Joseph Pitts, R-Pa.; Michael Burgess, R-Texas; and Cliff Stearns, R-Fla.

It was written to Susan Voss, Iowa insurance commissioner and president of the NAIC; Jane Cline, former West Virginia commissioner and former NAIC president; and Sandy Praeger, Kansas commissioner and head of the NAIC task force that adopted the regulations forwarded to the HHS for implementation.

The letter says that in numerous hearings on the issue, "several witnesses gave testimony regarding the law's harmful impacts on jobs in the agent and broker community."

"We have also heard testimony regarding the negative impacts of the MLR provision on patient choice in health coverage, as well as its deleterious effects on health care quality and the prevention of fraud."

It asks if and with whom HHS officials had discussed the MLR regulation.

Ethan Rome, executive director of Health Care for America Now, reacted to the new effort by saying: "A year after an exhaustive public process that produced a high-quality, unanimous recommendation on the medical loss ratio, the Republicans in Congress are abusing their power by launching a fishing expedition that questions the insurance commissioners' integrity."