Backdoor to socialized medicine?

[SK in CV]

If this is what you’ve been told, you’ve been told wrong.

The law provides that insurance sold to large group markets must have at least an 85% loss ratio, and those serving small groups and individuals must have at least an 80% medical loss ratio (MLR). The loss ratio is the percentage of premium dollar that pays for health care. If loss ratios do not meet these floors, then the shortfall must be refunded to policyholders. The remaining 15 to 20% is available for overhead and profit.

At least 15 states, already have similar regulations, or at least regulations which address MLRs.

In the late 80’s and early 90’s, when I did quite a bit of medical financing consulting, loss ratios hovered around 90% and above. Kaiser was pretty consistent in the 95% range. Over the last 20 years, those ratios have consistently fallen. Now they’re much more typically in the low 80’s and high 70’s. That extra 10 to 15% has all gone to pay exhorbitant overhead and profits, which have grown significantly faster than actual medical costs over the last 20 years.

[jeeman]

With 4.5% profit margins, insurers are hardly making a killing. McDonalds runs a 20% margin. I don’t understand the demonizers saying that insurers are making obscene profits off of sick people. With allowing pre-existing condition people to hop on whenever they want, it will collapse the private insurers, unless they raise premiums.

And when they do, Obama will further demonize them and attempt his government takeover of private medicine. People working the health industry will know this to be true.

[jeeman]

With 4.5% profit margins, insurers are hardly making a killing. McDonalds runs a 20% margin. I don’t understand the demonizers saying that insurers are making obscene profits off of sick people. With allowing pre-existing condition people to hop on whenever they want, it will collapse the private insurers, unless they raise premiums.

And when they do, Obama will further demonize them and attempt his government takeover of private medicine. People working the health industry will know this to be true.

[jeeman]

With 4.5% profit margins, insurers are hardly making a killing. McDonalds runs a 20% margin. I don’t understand the demonizers saying that insurers are making obscene profits off of sick people. With allowing pre-existing condition people to hop on whenever they want, it will collapse the private insurers, unless they raise premiums.

And when they do, Obama will further demonize them and attempt his government takeover of private medicine. People working the health industry will know this to be true.

[jeeman]

With 4.5% profit margins, insurers are hardly making a killing. McDonalds runs a 20% margin. I don’t understand the demonizers saying that insurers are making obscene profits off of sick people. With allowing pre-existing condition people to hop on whenever they want, it will collapse the private insurers, unless they raise premiums.

And when they do, Obama will further demonize them and attempt his government takeover of private medicine. People working the health industry will know this to be true.

[jeeman]

With 4.5% profit margins, insurers are hardly making a killing. McDonalds runs a 20% margin. I don’t understand the demonizers saying that insurers are making obscene profits off of sick people. With allowing pre-existing condition people to hop on whenever they want, it will collapse the private insurers, unless they raise premiums.

And when they do, Obama will further demonize them and attempt his government takeover of private medicine. People working the health industry will know this to be true.

[Anonymous]

Get the facts on healthcare reform from the experts:

[Anonymous]

Get the facts on healthcare reform from the experts:

[Anonymous]

Get the facts on healthcare reform from the experts:

[Anonymous]

Get the facts on healthcare reform from the experts:

[Anonymous]

Get the facts on healthcare reform from the experts:

[Anonymous]

[quote=beanmaestro]Maybe I misread, but I understood that while children can’t be denied for pre-existing conditions, adults can. There’s supposed to be a high-risk pool for adults with pre-existing conditions, so if we do see people gaming the system, the cost of the high risk policies could go way up, even if they’re non-profit pools. Can anyone confirm or deny that?
[/quote]

Part of an email I received from Senator Bernie Sanders:

What Health Care Reform Means for You Today:

* No Denials for Pre-Existing Conditions Insurers may no longer exclude individuals under 19 years old with pre-existing medical conditions. The age limit increases over time. By 2014, people with pre-existing conditions could no longer be denied insurance.

* More Young Adults Insured Parents will be allowed to keep their children on their health insurance plan until age 26.

* Broader Coverage Within 90 days, people who have been locked out of the insurance market because of a pre-existing condition would be eligible for coverage.

* Insurance Stability All insurance plans will be barred from imposing lifetime caps on coverage. Insurers can no longer cancel insurance retroactively except for outright fraud.

* Prescription Drugs The 4 million Medicare beneficiaries with prescription drug bills so high they are not fully covered will get a $250 rebate this year. Next year, charges will be cut in half for seniors who fall into the Medicare coverage gap known as the doughnut hole.

* Tax Credits for Small Businesses Small business owners will no longer be forced to choose between offering health care and hiring new employees. Tax credits of up to 35 percent of premiums will help them insure their employees.

* Holding Down Premiums Insurers must report how much they spend on medical care versus administrative costs, a step that later will be followed by tighter government review of premium increases.

* Health Centers Funding for community health centers will begin to go up this year. About 40 million patients, twice as many as today, will be treated in community health centers within five years.

* Professional Training Investments in training more primary care doctors, nurses, nurse practitioners and physician assistants will begin later this year.

I think this bill is a backdoor to socialized medicine and I’m looking forward to it. The Republicans got totally outfoxed on this bill. They used to be great at politics, but now they are all-amateur-hour-all-the-time.

[Anonymous]

[quote=beanmaestro]Maybe I misread, but I understood that while children can’t be denied for pre-existing conditions, adults can. There’s supposed to be a high-risk pool for adults with pre-existing conditions, so if we do see people gaming the system, the cost of the high risk policies could go way up, even if they’re non-profit pools. Can anyone confirm or deny that?
[/quote]

Part of an email I received from Senator Bernie Sanders:

What Health Care Reform Means for You Today:

* No Denials for Pre-Existing Conditions Insurers may no longer exclude individuals under 19 years old with pre-existing medical conditions. The age limit increases over time. By 2014, people with pre-existing conditions could no longer be denied insurance.

* More Young Adults Insured Parents will be allowed to keep their children on their health insurance plan until age 26.

* Broader Coverage Within 90 days, people who have been locked out of the insurance market because of a pre-existing condition would be eligible for coverage.

* Insurance Stability All insurance plans will be barred from imposing lifetime caps on coverage. Insurers can no longer cancel insurance retroactively except for outright fraud.

* Prescription Drugs The 4 million Medicare beneficiaries with prescription drug bills so high they are not fully covered will get a $250 rebate this year. Next year, charges will be cut in half for seniors who fall into the Medicare coverage gap known as the doughnut hole.

* Tax Credits for Small Businesses Small business owners will no longer be forced to choose between offering health care and hiring new employees. Tax credits of up to 35 percent of premiums will help them insure their employees.

* Holding Down Premiums Insurers must report how much they spend on medical care versus administrative costs, a step that later will be followed by tighter government review of premium increases.

* Health Centers Funding for community health centers will begin to go up this year. About 40 million patients, twice as many as today, will be treated in community health centers within five years.

* Professional Training Investments in training more primary care doctors, nurses, nurse practitioners and physician assistants will begin later this year.

I think this bill is a backdoor to socialized medicine and I’m looking forward to it. The Republicans got totally outfoxed on this bill. They used to be great at politics, but now they are all-amateur-hour-all-the-time.

[Anonymous]

[quote=beanmaestro]Maybe I misread, but I understood that while children can’t be denied for pre-existing conditions, adults can. There’s supposed to be a high-risk pool for adults with pre-existing conditions, so if we do see people gaming the system, the cost of the high risk policies could go way up, even if they’re non-profit pools. Can anyone confirm or deny that?
[/quote]

Part of an email I received from Senator Bernie Sanders:

What Health Care Reform Means for You Today:

* No Denials for Pre-Existing Conditions Insurers may no longer exclude individuals under 19 years old with pre-existing medical conditions. The age limit increases over time. By 2014, people with pre-existing conditions could no longer be denied insurance.

* More Young Adults Insured Parents will be allowed to keep their children on their health insurance plan until age 26.

* Broader Coverage Within 90 days, people who have been locked out of the insurance market because of a pre-existing condition would be eligible for coverage.

* Insurance Stability All insurance plans will be barred from imposing lifetime caps on coverage. Insurers can no longer cancel insurance retroactively except for outright fraud.

* Prescription Drugs The 4 million Medicare beneficiaries with prescription drug bills so high they are not fully covered will get a $250 rebate this year. Next year, charges will be cut in half for seniors who fall into the Medicare coverage gap known as the doughnut hole.

* Tax Credits for Small Businesses Small business owners will no longer be forced to choose between offering health care and hiring new employees. Tax credits of up to 35 percent of premiums will help them insure their employees.

* Holding Down Premiums Insurers must report how much they spend on medical care versus administrative costs, a step that later will be followed by tighter government review of premium increases.

* Health Centers Funding for community health centers will begin to go up this year. About 40 million patients, twice as many as today, will be treated in community health centers within five years.

* Professional Training Investments in training more primary care doctors, nurses, nurse practitioners and physician assistants will begin later this year.

I think this bill is a backdoor to socialized medicine and I’m looking forward to it. The Republicans got totally outfoxed on this bill. They used to be great at politics, but now they are all-amateur-hour-all-the-time.

[Anonymous]

[quote=beanmaestro]Maybe I misread, but I understood that while children can’t be denied for pre-existing conditions, adults can. There’s supposed to be a high-risk pool for adults with pre-existing conditions, so if we do see people gaming the system, the cost of the high risk policies could go way up, even if they’re non-profit pools. Can anyone confirm or deny that?
[/quote]

Part of an email I received from Senator Bernie Sanders:

What Health Care Reform Means for You Today:

* No Denials for Pre-Existing Conditions Insurers may no longer exclude individuals under 19 years old with pre-existing medical conditions. The age limit increases over time. By 2014, people with pre-existing conditions could no longer be denied insurance.

* More Young Adults Insured Parents will be allowed to keep their children on their health insurance plan until age 26.

* Broader Coverage Within 90 days, people who have been locked out of the insurance market because of a pre-existing condition would be eligible for coverage.

* Insurance Stability All insurance plans will be barred from imposing lifetime caps on coverage. Insurers can no longer cancel insurance retroactively except for outright fraud.

* Prescription Drugs The 4 million Medicare beneficiaries with prescription drug bills so high they are not fully covered will get a $250 rebate this year. Next year, charges will be cut in half for seniors who fall into the Medicare coverage gap known as the doughnut hole.

* Tax Credits for Small Businesses Small business owners will no longer be forced to choose between offering health care and hiring new employees. Tax credits of up to 35 percent of premiums will help them insure their employees.

* Holding Down Premiums Insurers must report how much they spend on medical care versus administrative costs, a step that later will be followed by tighter government review of premium increases.

* Health Centers Funding for community health centers will begin to go up this year. About 40 million patients, twice as many as today, will be treated in community health centers within five years.

* Professional Training Investments in training more primary care doctors, nurses, nurse practitioners and physician assistants will begin later this year.

I think this bill is a backdoor to socialized medicine and I’m looking forward to it. The Republicans got totally outfoxed on this bill. They used to be great at politics, but now they are all-amateur-hour-all-the-time.

[Author]

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