The health care reform law may allow insurers to subtract state and federal taxes and to count as costs "activities that improve health care quality" before calculating how much revenue goes to direct medical care, according to a draft memo from National Association of Insurance Commissioners. Insurers must spend 80% to 85% of premium revenue on medical care. The state regulators group is writing recommendations for the medical-spending rules, and the memo is likely to change before it's submitted to HHS.

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