The National Association of Insurance Commissioners will meet this week to finalize work on its recommendations for the all-important medical loss ratio provision. At its crux, the formula -- as spelled out in the health reform law -- directs insurers to spend between 80 percent and 85 percent of the premiums they collect on direct medical care. Discussions among NAIC, HHS and others have focused on trying to define what should and should not count as a medical cost. One area that continues to come up is whether quality improvement measures, developed at the plan level, should be figured in as part of the equation. Insurers say yes, but others are more reserved.

So, with the stakeholders meeting this week and an HHS interim final rule on the matter soon to come, how broadly do you think government officials will go in defining the regulation?