Word: cigna
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...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 in the individual market on care, the company says it actually lost money in that category of customers, spending 120% of premiums collected on health care...
...acquaintance helped usher Potter out of obscurity. Avram Goldstein was once a reporter for Bloomberg News who met Potter while writing about Cigna. Goldstein, who now works for the pro-reform advocacy group Health Care for America Now!, heard that Potter was quietly reaching out to some pro-reform advocates about possibly going public. "I called him, and I said, 'Is this true? Are you seriously interested in this?,' " remembers Goldstein. "And he said, 'Yes, I think I am.' He had a little bit of trepidation." Goldstein helped connect Potter with Democratic Senator Jay Rockefeller, who chairs the committee before...
...record - the industry's motives. Potter warns that the industry's cooperation, which has been hailed by Democrats, is hogwash, a "charm offensive" designed to disguise its true motive: profit. "This is just a repeat of what they've done before," says Potter, who was hired by Cigna around the time of President Clinton's push for reform in the early 1990s. Insurers were then, as now, pledging change in order to improve health care for Americans...
Unlike Jeffrey Wigand, the tobacco-industry whistle-blower made famous in the movie The Insider, Potter doesn't have a smoking gun or secret documents to unveil. He signed a confidentiality agreement before leaving Cigna and intends to honor it. "I have no intention of disclosing any proprietary information," he says. For-profit health-insurance-industry practices Potter talks about, like rescission - dropping expensive-to-cover policyholders on grounds that they failed to disclose pre-existing health conditions - are not secrets. This is, in fact, how private health insurers make profits. In Potter's view, these practices just need more...
Although he's busy, Potter now earns far less than he did at Cigna, where he made "in the six figures." He's a nonsalaried consultant for the Center for Media and Democracy but has health-insurance coverage through his wife, who manages a Banana Republic store. It's a low-cost, high-deductible plan - a model that provides coverage for catastrophic illness but kicks in only after the policyholder spends thousands of dollars out of pocket first. In other words, it's an insurance-industry-friendly model that companies like Cigna would like to see spread under health-reform...