David Axelrod says 8.5 million Americans received rebates from health insurance companies in 2013

It’s not an easy time to be a supporter of the health care law. There’s rage at every turn, for the millions of policy cancellation notices in Americans’ mailboxes, for the faulty online marketplace, and for President Barack Obama’s leadership in general.

David Axelrod, Obama’s former campaign strategist and adviser, tried batting down the dearth of bad press with some positive statistics about the law Thursday on MSNBC’s Morning Joe.

The law allows young adults under 26 to stay on their parents’ plan, prohibits insurers from refusing coverage to children with pre-existing conditions, and eliminates lifetime caps, Axelrod said.

Plus, "8.5 million Americans have gotten rebate checks because their insurance companies were spending too much money on executive bonuses and administrative costs and not enough on health care."

Shortly after his segment, Axelrod took to Twitter and said he was talking about rebates sent in 2013.

We wanted to know if his point is accurate.

You’re probably wondering who got free money from their insurance companies, and why, because it likely wasn’t you.

One of the health care law’s many requirements demands health insurance companies spend at least 80 percent of each dollar they charge in premiums on medical care, not for administrative purposes. Policy wonks know it as the medical loss ratio, or the 80/20 rule (for larger employers, it’s more like the 85/15 rule, but that’s more than we need to know for this fact-check).

Some Americans know it as the way they got paid by their insurer. If a company spends less than 80 percent on medical services, it must return the difference to the consumer either as a cash payment or as a reduction in future payments.

Two-thirds of insurance companies were already meeting the ratio without a policy change, according to a 2011 Government Accountability Office study, though compliance varied upon policy type. For example, 77 percent of companies that sold to large employers with more than 100 employees met the 80/20 rule, while only 43 percent of companies serving customers in the individual market were in compliance. The ratio does not apply to self-funded plans.

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Insurance companies had to report their premiums and spending for the first time in 2011. Companies returned $1.1 billion in total rebates to 13.1 million policyholders in 2012, according to Centers for Medicare and Medicaid Services data.

Companies returned about half as much in rebates in 2013 to 8.85 million policyholders (Axelrod was citing the agency’s original estimate of 8.5 million recipients). The average rebate was $98.

So Axelrod is on somewhat solid ground here. But there’s a caveat.

While 8.85 million policyholders were due rebates, it doesn’t mean people are getting checks as Axelrod claimed. Our colleagues at PolitiFact  pointed this out in a statement from Obama over the summer. (Obama also tried to put a dollar amount on the checks, which led to a rating of Half True.)

About one-third, or 2.9 million people, received rebates for coverage in the individual market in 2013 (the proportion was about the same in 2012). That means they physically got a check. The rest of the rebates went to the small and large employers who manage health insurance plans for their employees.

Employers and employees often share the cost of health insurance, with employers picking up the bulk of the cost. In those cases, the rebate goes to the employer because they buy the insurance. But the law requires that the rebate be split proportionately. Employers can pay their employees in a lump sum, reduce future premiums or act by "applying the rebate in a manner that benefits its employees," such as shoring up the health fund or offering better benefits.

Again, the rebates came but they doesn’t mean it trickled down to policyholders in the form of a check.

Our ruling

Axelrod said, "8.5 million Americans have gotten rebate checks because their insurance companies were spending too much money on executive bonuses and administrative costs and not enough on health care."

He is correct on the number of rebates. However, like Obama before him, Axelrod’s claim isn’t clear on the fact that these checks are mostly going to employers who run plans for their workers, not individual Americans. Employers can then choose to pay their employees in a lump sum, reduce future premiums or act by "applying the rebate in a manner that benefits its employees," such as shoring up the health fund or offering better benefits.

We rate the statement Mostly True.