Word: care
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Until Senate Majority Harry Reid decided to scrap a government-run insurance plan in order to get the 60 votes needed to pass health care reform legislation, Sen. Jay Rockefeller was one of the chamber's most ardent public option supporters. Without a public option, the West Virginia Democrat feared, insurers - fattened by billions of dollars in new government subsidies and a new requirement that most Americans purchase insurance - would run rampant, jacking up prices and padding profits and executive salaries. But Rockefeller and several other Democratic senators also had their eye on a different way to keep insurer profit...
...callousness of the health insurance business. Companies that sell coverage consider revenues that go to pay for medical costs "losses,"; minimizing these losses by dropping sick customers and cherry-picking healthy ones is one way insurers currently stay profitable. But thanks to a provision inserted into the Senate health care bill at the last minute, the federal government may soon require insurers to "lose" 80% of premiums collected in the large group market and 85% in the individual and small group market. Insurers who don't operate at or above these thresholds would have to send rebates to customers. (MLRs...
...administrative costs like marketing, salaries and profit. "If you buy a gallon of milk and you end up with half a gallon, you're not really happy about that. But in that case, you can take it back to the store and get mad." (See the top 10 health care reform players...
Earlier this year Rockefeller - who is chairman of the Senate Commerce, Science and Transportation Committee - launched an investigation into MLRs. According to Rockefeller, in 2008, insurers in the individual market spent an average of 74% of premiums on health care, compared with 80% in the small group market and 84% in the large group market; some insurers cited in the final report spent as little as 66% of premiums on actual care. CIGNA, one of the insurance companies cited, says investigators erred in calculating the company's medical loss ratios. Where the report said CIGNA spent 87% of premiums...
...setting a new national MLR floor is not the end of the equation. The CBO, in its report on the regulations, said insurers might react to new thresholds by "cutting back on efforts to restrain benefit costs through care management." Translation: Anything that doesn't count as "medical costs" may be on the chopping block, including exorbitant executive salaries but also programs to keep patients healthy. There is also a fear among health policy experts that some insurers could raise premiums in reaction - higher premiums means more money spent on health care, but also more left over for profits. Another...