HC Reform Update by Mark Sanna: The new health care law requires health insurers to spend at least 80% of every dollar collected in premiums on the welfare of patients. The calculation of the medical-loss ratio is crucial to insurance companies, because the law requires them to refund money to consumers if they spend too much on administrative costs. An intense effort is now under way by insurance companies to retool this provision and state regulators are only now deciding what precisely it means.