About $2 billion in health insurance rebates would have been issued to over 15 million American consumers if the Affordable Care Act’s new medical loss ratio (MLR) rules had been in effect in 2010, a new study from The Commonwealth Fund reveals. The MLR rules, which were enacted in 2011, require a minimum percentage — ranging anywhere from 80-85 percent — of premium dollars to be spent on medical care and health care quality improvement, as opposed to administrative costs and corporate profits. The report, Estimating the Impact of the Medical Loss Ratio Rule: A State-by-State Analysis, estimates that had the MRL rule gone into effect a year earlier, the 5.3 million Americans with individual health insurance coverage would have received nearly $1 billion in rebates, while another $1 billion in rebates would have been awarded to the 10 million Americans with policies in both small and large group markets. Twenty-three percent of privately insured consumers in all markets would have received rebates.

Federal health officials estimate $323 million in MRL rebates for the first year (starting in 2011), “with the first round due to be paid by Aug. 1 this year, and each year thereafter.”

– Fatima Najiy

Mitt Romney typically promises to send the Medicaid program — a federal-state partnership that provides health care to the neediest Americans — back to the “states,” with a significantly reduced federal contribution. But this morning, during a rally in Harrisburg, Pennsylvania the former Massachusetts governor went even further, promising to let individuals deal with skyrocketing health care costs and access problems on their own:

ROMNEY: I want to return health care to the states. I will repeal Obamacare and let people have responsibility for their own health care.

Watch it:

Setting aside the hypocrisy of Romney’s “personal responsibility” advocacy — he, after all, would repeal a law that would require all able bodied Americans to take control of their own health care spending — it’s hard to believe that states can deal with the health care crisis on their own. Sure, a place like Massachusetts, which already enjoyed high insurance rates, can try to pass a universal coverage plan, but few others can — and no others have.

In fact, the history of state-based health care reform efforts is filled with false starts and dashed hopes, from California to Hawaii to Oregon, suggesting that the lessons from one state tend to be just that—applicable to one but not the rest. State uninsured rates vary greatly from just under 3 percent to almost 25 percent and, generally, where rates are the highest (i.e. Texas), governments have the least resources in terms of a tax base to support funding for needed coverage expansions or provide subsidies to their populations. Balance budget requirements also prevent many states from making meaningful long-term investments in reform and powerful health care industry lobbyists often stand in the way of reforms that could reduce industry profits. Recessions also complicate the process, as governors and legislators often have to cut health care programs, just as their enrollment skyrockets and state costs increase.

So as Romney well knows, the system is simply stacked against state efforts. It’s a shame that he’s now pretending otherwise.

Newt Gingrich’s campaign isn’t the only entity that’s struggling to raise money in what now increasingly looks like the former Speaker’s losing bid to stay relevant. The Atlanta Business Chronicle is reporting that Gingrich’s health care think thank — the Center for Health Transformation — has filed for Chapter 7 bankruptcy. The organization “which has offices in Washington, D.C., Atlanta, and St. Louis, plans to liquidate its assets” and has “listed estimated liabilities of $1 million to $10 million dollars and 50 to 90 creditors.” The filing:

The for-profit Center served approximately 94 health industry corporations and lobby groups, including health insurance (BlueCross BlueShield Association, WellPoint, AHIP, UnitedHealth), health IT (L-3 Enterprise, Microsoft, IBM), and pharmaceutical companies — with each paying up to $200,000 annually. Gingrich touted the organization as a place of innovation and fresh thinking, but came under criticism from conservatives after recordings surfaced of him touting the Affordable Care Act’s individual mandate in a call with health care clients from May 2009. The Center also prominently promoted a federal individual health insurance mandate on its website.