A major reason health insurance companies dropping out of Obamacare

[nat4900]

Most of you don't comprehend what that means. It was very simple.
The average health insurance company paid out 80¢ for every $1 in premium.
Obamacare required a minimum of 80¢ and as much as 85¢!
That would leave the insurance companies 15¢ for ALL OTHER EXPENSES but most importantly very little in profit.
NOW most of you idiots say well that's good. They make too much profit as it is!
DUMMIES!!!

Here, as an example, is where premiums from cancer-ridden patients MUST go toward (according to ACA opponents.)

• Cigna CEO David Cordani: $17.3 million. Cordani's total compensation rose considerably compared to 2014, when he pulled in $14.5 million. ...
• Aetna CEO Mark Bertolini: $17.3 million. ...
• UnitedHealth CEO Stephen Hemsley: $14.5 million. ...
• Anthem CEO Joseph Swedish: $13.6 million. ...
• Humana CEO Bruce Broussard: $10.3 million.

 

[Treeshepherd]

Most of you don't comprehend what that means. It was very simple.
The average health insurance company paid out 80¢ for every $1 in premium.
Obamacare required a minimum of 80¢ and as much as 85¢!
That would leave the insurance companies 15¢ for ALL OTHER EXPENSES but most importantly very little in profit.
NOW most of you idiots say well that's good. They make too much profit as it is!
DUMMIES!!!

Here, as an example, is where premiums from cancer-ridden patients MUST go toward (according to ACA opponents.)

• Cigna CEO David Cordani: $17.3 million. Cordani's total compensation rose considerably compared to 2014, when he pulled in $14.5 million. ...
• Aetna CEO Mark Bertolini: $17.3 million. ...
• UnitedHealth CEO Stephen Hemsley: $14.5 million. ...
• Anthem CEO Joseph Swedish: $13.6 million. ...
• Humana CEO Bruce Broussard: $10.3 million.

Obamacare mandated that administrative costs would be capped at a certain number, I think around 20℅. It was pretty easy for insurance companies to figure out that they could merge their company with another large company, downsize their collective staffs, and reward the CEOs. Many did merge and now there are fewer insurance companies and less competition, and each surviving company has become larger and more powerful at lobbying (too big to fail).

 

[there4eyeM]

As a race of social animals, humans have a choice of maximizing their capacities together or not. Sociopaths do not feel the positive impetus.

 

[NightFox]

As a race of social animals, humans have a choice of maximizing their capacities together or not. Sociopaths do not feel the positive impetus.

Uh-huh, this explains why the fact that the motives of certain groups among the citizenry who consistently promote the increase in power, expense and scope of a historically anti-social institution like the state is a complete mystery to some of us.

Apparently they're either sociopaths themselves or are so blind to the implications of past and current events that they think neither one matters and are instead singularly concerned with getting their way by any means necessary.

"The argument for liberty is not an argument against organization, which is one of the most powerful tools human reason can employ, but an argument against all exclusive, privileged, monopolistic organization, against the use of coercion to prevent others from doing better." -- Friedrich August von Hayek, the Road to Serfdom

 

[Care4all]

Unbeknownst to a vast majority of people is a gigantic show stopper that was part of Obamacare.
The Affordable Care Act requires health insurance issuers to submit data on the proportion of premium revenues spent on clinical services and quality improvement, also known as the Medical Loss Ratio (MLR). It also requires them to issue rebates to enrollees if this percentage does not meet minimum standards. The Affordable Care Act requires insurance companies to spend at least 80% or 85% of premium dollars on medical care, with the rate review provisions imposing tighter limits on health insurance rate increases. If an issuer fails to meet the applicable MLR standard in any given year, as of 2012, the issuer is required to provide a rebate to its customers.Medical Loss Ratio - Centers for Medicare & Medicaid Services

Simply put, if an insurance company DOESN"T SPEND at least 80 to 85% of premium dollars on claims...they have to rebate to customers.

Most of you don't comprehend what that means. It was very simple.
The average health insurance company paid out 80¢ for every $1 in premium.
Obamacare required a minimum of 80¢ and as much as 85¢!
That would leave the insurance companies 15¢ for ALL OTHER EXPENSES but most importantly very little in profit.
NOW most of you idiots say well that's good. They make too much profit as it is!
DUMMIES!!!

Where do you think the insurance companies build reserves for future claims? Reserves required by state insurance regulations to be able to sell in the states!
Reserves come from profits. If health insurance companies have operating expenses greater then
15% guess what ? NO Profits. NO profits mean no reserves. No reserves means the state won't let them
sell!
That's why Kentucky’s co-op posted a “medical loss” ratio of 158% for 2014 – for every premium dollar it collected, it spent that dollar and an additional 58 cents on the cost of claims. The co-op now had even less of a margin for error after exhausting its existing federal loan allocations. That sort of performance was not sustainable for Kentucky or for the many other co-ops that are similarly challenged.
400,000 Citizens To Lose Health Insurance (Again) Because Of Obamacare Co-Op Failures


However, the ill-designed structure of the MLR provision may actually have the opposite effect, for two reasons:
First, it is likely to require higher average annual premiums (averaged over several years) for insurers to meet state solvency requirements.
Second, it might end up rewarding who raise premiums.
Those insurers with higher premiums will have to pay higher rebates to consumers, but the MLR formula (probably inadvertently) allows them to retain higher profits if they do so. Furthermore, since a majority of the population will be eligible for subsidies that insulate them from the cost of higher premiums (but still allow them to benefit from rebates), rebates might be used to “pay” customers to enroll in high-premium plans, in effect transferring to insurers large – and potentially unbounded – sums from taxpayers in the form of subsidies unrelated to medical costs. The result could turn out to be free, or even better-than-free, insurance for some individuals and families, and huge profits for insurers – all at the expense of taxpayers.

Rather than restraining insurance profits, the MLR rebates could become a vehicle for funneling taxpayer dollars from the federal government to subsidized consumers and to insurance company profits. In addition, the MLR formula allows insurers who know they will be paying a rebate to increase their medical spending without reducing their profits, thus bending the “cost curve” upward rather than downward.
https://www.americanactionforum.org/wp-content/uploads/files/research/MLR_Paper_Final.pdf

Second, it might end up rewarding who raise premiums.
Those insurers with higher premiums will have to pay higher rebates to consumers, but the MLR formula (probably inadvertently) allows them to retain higher profits if they do so. Furthermore, since a majority of the population will be eligible for subsidies that insulate them from the cost of higher premiums (but still allow them to benefit from rebates), rebates might be used to “pay” customers to enroll in high-premium plans, in effect transferring to insurers large – and potentially unbounded – sums from taxpayers in the form of subsidies unrelated to medical costs. The result could turn out to be free, or even better-than-free, insurance for some individuals and families, and huge profits for insurers – all at the expense of taxpayers.

Let me address this part and why it is completely WRONG.

The Feds only reimburse insurance companies up to the cheapest plan available in that category from all insurance companies offering plans.

Let's say I was going to buy a Silver Plan, and there were 10 plans from various Insurance Companies, available on the exchange to choose from....and assume I am a very low income citizen.

Silver Plan 1 $1000 a month premium- $800 in Subsidy/ $200 a month for citizen.

Silver Plan 2 $1200 a month premium- $800 in Subsidy/ $400 a month for citizen.

Silver Plan 3 $1400 a month premium- $800 in Subsidy/ $600 a month for citizen.



The government does not reimburse through the insurers with their subsidy, for "whatever" proportionate price of the plan for the citizen's income level..

The government only reimburses with subsidy, for a citizen's income level,for the lowest priced plan in that Silver Category, or that Bronze Category etc

There is no incentive for citizens or Insurers, if they have their plans priced more than the lowest price plan in that category....the subsidy given by the govt does NOT go up, for the insurers who offer plans at a higher price in that category!!! IT DOES NOT incentivize insurers to go with a higher price for their silver plans....because the citizen is only going to get the $800 subsidy, and ANYTHING OVER that $800 comes out of the citizen's pocket....LOOK AT MY EXAMPLE....

This pushes citizens in to the lowest priced plan in the Silver category, and discourages citizens going with a higher priced silver plan from another insurer, and it forces Insurance Companies to try to come as close as they can with their Silver plan's LOWEST priced Silver plan.

so, the lady writing the op is simply wrong in her opinion.

 

[healthmyths]

Most of you don't comprehend what that means. It was very simple.
The average health insurance company paid out 80¢ for every $1 in premium.
Obamacare required a minimum of 80¢ and as much as 85¢!
That would leave the insurance companies 15¢ for ALL OTHER EXPENSES but most importantly very little in profit.
NOW most of you idiots say well that's good. They make too much profit as it is!
DUMMIES!!!

Here, as an example, is where premiums from cancer-ridden patients MUST go toward (according to ACA opponents.)

• Cigna CEO David Cordani: $17.3 million. Cordani's total compensation rose considerably compared to 2014, when he pulled in $14.5 million. ...
• Aetna CEO Mark Bertolini: $17.3 million. ...
• UnitedHealth CEO Stephen Hemsley: $14.5 million. ...
• Anthem CEO Joseph Swedish: $13.6 million. ...
• Humana CEO Bruce Broussard: $10.3 million.

Obamacare mandated that administrative costs would be capped at a certain number, I think around 20℅. It was pretty easy for insurance companies to figure out that they could merge their company with another large company, downsize their collective staffs, and reward the CEOs. Many did merge and now there are fewer insurance companies and less competition, and each surviving company has become larger and more powerful at lobbying (too big to fail).

If you meant the medical loss ratio had to be at least 85% of all premiums per ACA that is what was required. As a result this crap about
CEOs salaries etc. is just that.
Case in point Aetna CEO $17.3 million is exactly $4.24 billion BEFORE TAXES!!! His salary: 0.004%!
Plus I'd like to see idiots that complain about those salaries take on the enormous responsibilities of decisions the CEO makes!
Decisions regarding the future of 47,000 employees. 13 million insured people. I'd like to see idiots that complain about these CEOs
salaries try for just one day to make these decisions that affect millions of people's lives.
Dummies like those that complain about CEOs salaries are just plain DUMB!

 

[Winston]

Unbeknownst to a vast majority of people is a gigantic show stopper that was part of Obamacare.
The Affordable Care Act requires health insurance issuers to submit data on the proportion of premium revenues spent on clinical services and quality improvement, also known as the Medical Loss Ratio (MLR).

Wow. You don't understand the insurance industry do you? Medical Loss Ratio's have been in use for as long as I have been in the business--so that is more than twenty years. In my state, they have always been used when approving rate increases. The Medicare Supplement market was standardized in the 1990's. MLR's were established at that time and the Medicare supplement market is the most profitable market in the health insurance industry. MLR's have been in place for group insurance throughout my entire career. Most Americans get their health insurance via a group policy that have had required MLR's of eighty percent for as long as I can remember.

Insurance is a pretty sweet gig. It is the only business in the world where you can slap a label on "profit" and call it a "loss reserve" and not have to pay taxes on it. Better yet, you don't even have to pay taxes on any earnings you can get out of that "loss reserve". It is the very reason MLR's are calculated and used by regulators to justify rate increases. Let me explain how it works for most large companies.

First, the company is "self-insured", which--like most names today is very misleading. The company pays an entity to oversee the plan. The company contributes money into the plan and pays for all the health care claims of the employees up to a certain amount, their loss limit. If claims exceed that amount, the insurance company pays it. If they do not exceed that amount, the company gets to keep the excess and call it a "loss reserve". They get to write it off as an expense and yet the money is sitting somewhere EARNING interest TAXFREE.

Now used to be, companies would collect "premiums" from their employees. Turn a profit on the whole insurance bit and build up a cash reserve over years. In the end, the company executives would raid the cash reserve and use that money to take the company private. They paid no taxes on the "profit" from the insurance they "sold" their employees. They paid no taxes on the earnings of those profits. And then, they use the money, funded by the employees to buy the company itself.

Can't do it anymore. The bomb in the ACA was not the use of the MLR. The bomb in the ACA was the ruling that those "reserves" were not the companies money--they belonged to the employees. And now those companies have a fiduciary responsibility to the EMPLOYEES, and they can't take the EMPLOYEE"S money to enrich themselves. And even if they are not self-insured, the ACA requires their provider to rebate to them, not the beneficiaries, any shortfall to the MLR, with the same fiduciary responsibility as a self-insured entity.

 

[Treeshepherd]

Most of you don't comprehend what that means. It was very simple.
The average health insurance company paid out 80¢ for every $1 in premium.
Obamacare required a minimum of 80¢ and as much as 85¢!
That would leave the insurance companies 15¢ for ALL OTHER EXPENSES but most importantly very little in profit.
NOW most of you idiots say well that's good. They make too much profit as it is!
DUMMIES!!!

Here, as an example, is where premiums from cancer-ridden patients MUST go toward (according to ACA opponents.)

• Cigna CEO David Cordani: $17.3 million. Cordani's total compensation rose considerably compared to 2014, when he pulled in $14.5 million. ...
• Aetna CEO Mark Bertolini: $17.3 million. ...
• UnitedHealth CEO Stephen Hemsley: $14.5 million. ...
• Anthem CEO Joseph Swedish: $13.6 million. ...
• Humana CEO Bruce Broussard: $10.3 million.

Obamacare mandated that administrative costs would be capped at a certain number, I think around 20℅. It was pretty easy for insurance companies to figure out that they could merge their company with another large company, downsize their collective staffs, and reward the CEOs. Many did merge and now there are fewer insurance companies and less competition, and each surviving company has become larger and more powerful at lobbying (too big to fail).

If you meant the medical loss ratio had to be at least 85% of all premiums per ACA that is what was required. As a result this crap about
CEOs salaries etc. is just that.
Case in point Aetna CEO $17.3 million is exactly $4.24 billion BEFORE TAXES!!! His salary: 0.004%!
Plus I'd like to see idiots that complain about those salaries take on the enormous responsibilities of decisions the CEO makes!
Decisions regarding the future of 47,000 employees. 13 million insured people. I'd like to see idiots that complain about these CEOs
salaries try for just one day to make these decisions that affect millions of people's lives.
Dummies like those that complain about CEOs salaries are just plain DUMB!

Call it the 80/20 rule (85-15 in some cases), or phrase it in terms of MLR. The point is that it led to mergers, which lead to less competition and higher premiums

 

[Winston]

Unbeknownst to a vast majority of people is a gigantic show stopper that was part of Obamacare.
The Affordable Care Act requires health insurance issuers to submit data on the proportion of premium revenues spent on clinical services and quality improvement, also known as the Medical Loss Ratio (MLR). It also requires them to issue rebates to enrollees if this percentage does not meet minimum standards. The Affordable Care Act requires insurance companies to spend at least 80% or 85% of premium dollars on medical care, with the rate review provisions imposing tighter limits on health insurance rate increases. If an issuer fails to meet the applicable MLR standard in any given year, as of 2012, the issuer is required to provide a rebate to its customers.Medical Loss Ratio - Centers for Medicare & Medicaid Services

Simply put, if an insurance company DOESN"T SPEND at least 80 to 85% of premium dollars on claims...they have to rebate to customers.

Most of you don't comprehend what that means. It was very simple.
The average health insurance company paid out 80¢ for every $1 in premium.
Obamacare required a minimum of 80¢ and as much as 85¢!
That would leave the insurance companies 15¢ for ALL OTHER EXPENSES but most importantly very little in profit.
NOW most of you idiots say well that's good. They make too much profit as it is!
DUMMIES!!!

Where do you think the insurance companies build reserves for future claims? Reserves required by state insurance regulations to be able to sell in the states!
Reserves come from profits. If health insurance companies have operating expenses greater then
15% guess what ? NO Profits. NO profits mean no reserves. No reserves means the state won't let them
sell!
That's why Kentucky’s co-op posted a “medical loss” ratio of 158% for 2014 – for every premium dollar it collected, it spent that dollar and an additional 58 cents on the cost of claims. The co-op now had even less of a margin for error after exhausting its existing federal loan allocations. That sort of performance was not sustainable for Kentucky or for the many other co-ops that are similarly challenged.
400,000 Citizens To Lose Health Insurance (Again) Because Of Obamacare Co-Op Failures


However, the ill-designed structure of the MLR provision may actually have the opposite effect, for two reasons:
First, it is likely to require higher average annual premiums (averaged over several years) for insurers to meet state solvency requirements.
Second, it might end up rewarding who raise premiums.
Those insurers with higher premiums will have to pay higher rebates to consumers, but the MLR formula (probably inadvertently) allows them to retain higher profits if they do so. Furthermore, since a majority of the population will be eligible for subsidies that insulate them from the cost of higher premiums (but still allow them to benefit from rebates), rebates might be used to “pay” customers to enroll in high-premium plans, in effect transferring to insurers large – and potentially unbounded – sums from taxpayers in the form of subsidies unrelated to medical costs. The result could turn out to be free, or even better-than-free, insurance for some individuals and families, and huge profits for insurers – all at the expense of taxpayers.

Rather than restraining insurance profits, the MLR rebates could become a vehicle for funneling taxpayer dollars from the federal government to subsidized consumers and to insurance company profits. In addition, the MLR formula allows insurers who know they will be paying a rebate to increase their medical spending without reducing their profits, thus bending the “cost curve” upward rather than downward.
https://www.americanactionforum.org/wp-content/uploads/files/research/MLR_Paper_Final.pdf

Second, it might end up rewarding who raise premiums.
Those insurers with higher premiums will have to pay higher rebates to consumers, but the MLR formula (probably inadvertently) allows them to retain higher profits if they do so. Furthermore, since a majority of the population will be eligible for subsidies that insulate them from the cost of higher premiums (but still allow them to benefit from rebates), rebates might be used to “pay” customers to enroll in high-premium plans, in effect transferring to insurers large – and potentially unbounded – sums from taxpayers in the form of subsidies unrelated to medical costs. The result could turn out to be free, or even better-than-free, insurance for some individuals and families, and huge profits for insurers – all at the expense of taxpayers.

Let me address this part and why it is completely WRONG.

The Feds only reimburse insurance companies up to the cheapest plan available in that category from all insurance companies offering plans.

Let's say I was going to buy a Silver Plan, and there were 10 plans from various Insurance Companies, available on the exchange to choose from....and assume I am a very low income citizen.

Silver Plan 1 $1000 a month premium- $800 in Subsidy/ $200 a month for citizen.

Silver Plan 2 $1200 a month premium- $800 in Subsidy/ $400 a month for citizen.

Silver Plan 3 $1400 a month premium- $800 in Subsidy/ $600 a month for citizen.



The government does not reimburse through the insurers with their subsidy, for "whatever" proportionate price of the plan for the citizen's income level..

The government only reimburses with subsidy, for a citizen's income level,for the lowest priced plan in that Silver Category, or that Bronze Category etc

There is no incentive for citizens or Insurers, if they have their plans priced more than the lowest price plan in that category....the subsidy given by the govt does NOT go up, for the insurers who offer plans at a higher price in that category!!! IT DOES NOT incentivize insurers to go with a higher price for their silver plans....because the citizen is only going to get the $800 subsidy, and ANYTHING OVER that $800 comes out of the citizen's pocket....LOOK AT MY EXAMPLE....

This pushes citizens in to the lowest priced plan in the Silver category, and discourages citizens going with a higher priced silver plan from another insurer, and it forces Insurance Companies to try to come as close as they can with their Silver plan's LOWEST priced Silver plan.

so, the lady writing the op is simply wrong in her opinion.

You are absolutely correct. The subsidy is based on income and dependents and has nothing to do with the premium. However, there is another subsidy, paid by the government on behalf of low income beneficiaries, to pay for part of the deductible and some on the copays of the Silver Plans. It is this subsidy that will test the Trump administration.

Day one, Trump can stop that subsidy. No Congress needed. No executive order needed. The courts have ruled that particular subsidy as unconstitutional and the Obama administration has appealed. The courts have allowed the government to continue to pay that subsidy pending the appeal. The Trump administration can withdraw the appeal and the subsidy stops immediately. But here is the kicker--if the government doesn't pay it the insurance companies are PREVENTED BY LAW from collecting it from the beneficiaries. They have to EAT IT.

So he can do it. He can eliminate one of the costly provisions of Obamacare. But he won't be sticking it to low income workers. He will be sticking it to the insurance companies. I am betting that with those small hands there is no way he has the balls to do it.

 

[Winston]

Call it the 80/20 rule (85-15 in some cases), or phrase it in terms of MLR. The point is that it led to mergers, which lead to less competition and higher premiums

That makes no sense whatsoever. First off, merging would lead to larger groups requiring an 85% MLR, not 80%. Second, economies of scale would lower both administrative and health care expenditures on a per beneficiary basis. Third, your proposition violates the primary rule of insurance, more diversification of risk leads to less risk exposure per person. The fact is that the MLR has been the primary means of keeping insurance premiums in line for DECADES and is nothing new from the ACA.

 

[healthmyths]

Unbeknownst to a vast majority of people is a gigantic show stopper that was part of Obamacare.
The Affordable Care Act requires health insurance issuers to submit data on the proportion of premium revenues spent on clinical services and quality improvement, also known as the Medical Loss Ratio (MLR).

Wow. You don't understand the insurance industry do you? Medical Loss Ratio's have been in use for as long as I have been in the business--so that is more than twenty years. In my state, they have always been used when approving rate increases. The Medicare Supplement market was standardized in the 1990's. MLR's were established at that time and the Medicare supplement market is the most profitable market in the health insurance industry. MLR's have been in place for group insurance throughout my entire career. Most Americans get their health insurance via a group policy that have had required MLR's of eighty percent for as long as I can remember.

Insurance is a pretty sweet gig. It is the only business in the world where you can slap a label on "profit" and call it a "loss reserve" and not have to pay taxes on it. Better yet, you don't even have to pay taxes on any earnings you can get out of that "loss reserve". It is the very reason MLR's are calculated and used by regulators to justify rate increases. Let me explain how it works for most large companies.

First, the company is "self-insured", which--like most names today is very misleading. The company pays an entity to oversee the plan. The company contributes money into the plan and pays for all the health care claims of the employees up to a certain amount, their loss limit. If claims exceed that amount, the insurance company pays it. If they do not exceed that amount, the company gets to keep the excess and call it a "loss reserve". They get to write it off as an expense and yet the money is sitting somewhere EARNING interest TAXFREE.

Now used to be, companies would collect "premiums" from their employees. Turn a profit on the whole insurance bit and build up a cash reserve over years. In the end, the company executives would raid the cash reserve and use that money to take the company private. They paid no taxes on the "profit" from the insurance they "sold" their employees. They paid no taxes on the earnings of those profits. And then, they use the money, funded by the employees to buy the company itself.

Can't do it anymore. The bomb in the ACA was not the use of the MLR. The bomb in the ACA was the ruling that those "reserves" were not the companies money--they belonged to the employees. And now those companies have a fiduciary responsibility to the EMPLOYEES, and they can't take the EMPLOYEE"S money to enrich themselves. And even if they are not self-insured, the ACA requires their provider to rebate to them, not the beneficiaries, any shortfall to the MLR, with the same fiduciary responsibility as a self-insured entity.

Wow and I've been working strictly with Medicare for nearly 20 years also and I understand Federal government requirements Vis-à-vis the
gross misunderstanding of many people and obviously YOU regarding MLR!

AGAIN for you people that don't comprehend...
MLRs are used by state insurance regulators to approve/disapprove insurance premiums.
Historically average MLR has been around 80% of all premiums go towards paying claims.
But the idiots i.e. Gruber who called Americans Stupid for passing ACA evidently didn't know that by jacking the MLR to 85% that
was going to reduce remaining operating revenue by 5%.

And here is the study that proves it!

Because both medical claims and administrative expenses increased more than premiums in 2014, health insurers’ overall operating profits (known as underwriting gain) diminished noticeably from previous years.
This was especially pronounced in the individual market, where the 4.2 percent underwriting loss was three points greater than the underwriting loss two years earlier. Insurers overall showed a small profit margin in 2014 of 1 percent, aided by offsetting gains in the group market, but this was well less than half of the profit margin in prior years.
How Has the Affordable Care Act Affected Health Insurers' Financial Performance?

Finally again think about the concept of "profit"! Evil, profits. BAD profits! And then consider the below charts!
2¢ profit! 13¢ administration costs.. the rest health care claims! Out of every dollar in premium.

https://www.quora.com/Obamacare-Rol...es-the-ACA-cap-profits-of-insurance-companies

 

[nat4900]

But the idiots i.e. Gruber who called Americans Stupid for passing ACA evidently didn't know that by jacking the MLR to 85% that
was going to reduce remaining operating revenue by 5%.

Would the above then mean that premiums should have gone up by ONLY 5%.???

 

[SavannahMann]

Is auto insurance required?

No. If you own a car you have to buy insurance, but if you are one of the millions who do not own a car there is no requirement to buy insurance for the non existent auto.

I don't have insurance on a plane. I don't own a plane. I don't have boat insurance either. I don't own a boat. So insurance offers for boat or plane insurance don't interest me.

I don't have and don't need motorcycle insurance. Should I and others have to buy it because it would make it cheaper for others to have insurance on those items?

But back to auto insurance. My state only mandates liability insurance. Shouldn't they mandate full coverage including flood and uninsured drivers and all the other little add on policies? That's what Obamacare is. Requiring me to buy coverage for eight people who might be in my four seat hatchback. This is because some people have big vans.

I would be required to have trailer coverage even if my car doesn't have a trailer hitch and couldn't pull a grocery cart with it's limited horsepower. It would be requiring the same insurance for a Smart Car as for a million dollar collectors car.

We all have to have the same insurance including child birth even if my wife and I can't have any. Or if I'm unmarried, or gay.

 

[healthmyths]

But the idiots i.e. Gruber who called Americans Stupid for passing ACA evidently didn't know that by jacking the MLR to 85% that
was going to reduce remaining operating revenue by 5%.

Would the above then mean that premiums should have gone up by ONLY 5%.???

No.

 

[Winston]

Unbeknownst to a vast majority of people is a gigantic show stopper that was part of Obamacare.
The Affordable Care Act requires health insurance issuers to submit data on the proportion of premium revenues spent on clinical services and quality improvement, also known as the Medical Loss Ratio (MLR).

Wow. You don't understand the insurance industry do you? Medical Loss Ratio's have been in use for as long as I have been in the business--so that is more than twenty years. In my state, they have always been used when approving rate increases. The Medicare Supplement market was standardized in the 1990's. MLR's were established at that time and the Medicare supplement market is the most profitable market in the health insurance industry. MLR's have been in place for group insurance throughout my entire career. Most Americans get their health insurance via a group policy that have had required MLR's of eighty percent for as long as I can remember.

Insurance is a pretty sweet gig. It is the only business in the world where you can slap a label on "profit" and call it a "loss reserve" and not have to pay taxes on it. Better yet, you don't even have to pay taxes on any earnings you can get out of that "loss reserve". It is the very reason MLR's are calculated and used by regulators to justify rate increases. Let me explain how it works for most large companies.

First, the company is "self-insured", which--like most names today is very misleading. The company pays an entity to oversee the plan. The company contributes money into the plan and pays for all the health care claims of the employees up to a certain amount, their loss limit. If claims exceed that amount, the insurance company pays it. If they do not exceed that amount, the company gets to keep the excess and call it a "loss reserve". They get to write it off as an expense and yet the money is sitting somewhere EARNING interest TAXFREE.

Now used to be, companies would collect "premiums" from their employees. Turn a profit on the whole insurance bit and build up a cash reserve over years. In the end, the company executives would raid the cash reserve and use that money to take the company private. They paid no taxes on the "profit" from the insurance they "sold" their employees. They paid no taxes on the earnings of those profits. And then, they use the money, funded by the employees to buy the company itself.

Can't do it anymore. The bomb in the ACA was not the use of the MLR. The bomb in the ACA was the ruling that those "reserves" were not the companies money--they belonged to the employees. And now those companies have a fiduciary responsibility to the EMPLOYEES, and they can't take the EMPLOYEE"S money to enrich themselves. And even if they are not self-insured, the ACA requires their provider to rebate to them, not the beneficiaries, any shortfall to the MLR, with the same fiduciary responsibility as a self-insured entity.

Wow and I've been working strictly with Medicare for nearly 20 years also and I understand Federal government requirements Vis-à-vis the
gross misunderstanding of many people and obviously YOU regarding MLR!

AGAIN for you people that don't comprehend...
MLRs are used by state insurance regulators to approve/disapprove insurance premiums.
Historically average MLR has been around 80% of all premiums go towards paying claims.
But the idiots i.e. Gruber who called Americans Stupid for passing ACA evidently didn't know that by jacking the MLR to 85% that
was going to reduce remaining operating revenue by 5%.

And here is the study that proves it!

Because both medical claims and administrative expenses increased more than premiums in 2014, health insurers’ overall operating profits (known as underwriting gain) diminished noticeably from previous years.
This was especially pronounced in the individual market, where the 4.2 percent underwriting loss was three points greater than the underwriting loss two years earlier. Insurers overall showed a small profit margin in 2014 of 1 percent, aided by offsetting gains in the group market, but this was well less than half of the profit margin in prior years.
How Has the Affordable Care Act Affected Health Insurers' Financial Performance?

Finally again think about the concept of "profit"! Evil, profits. BAD profits! And then consider the below charts!
2¢ profit! 13¢ administration costs.. the rest health care claims! Out of every dollar in premium.
View attachment 106532

https://www.quora.com/Obamacare-Rol...es-the-ACA-cap-profits-of-insurance-companies

Come on man. Medicare exclusively for twenty years? Then you know that claim about 15% limit on administrative expenses is horseshit. The entire 15% wouldn't fund your commission on a med sup. And I don't know at what level you are but twenty percent is not enough to fund most of my contracts.

And profit, you damn right you can throw that out the window. It does not bear any resemblance to reality in the insurance business. That little dollar bill graph you got--it shows what happens to each premium dollar. It does not even consider the earnings on those loss reserves. Put another way, what happens to each dollar Blue Cross and Blue Shield EARNED from their loss reserves. Last I heard, BCBS of California had over FOUR BILLION dollars in reserve. Honestly, who do you think owns the office building your office is in, or the mall where you shop. I doubt it is Donald Trump. More than likely, some insurance company holds it in their loss reserves.

 

[healthmyths]

Unbeknownst to a vast majority of people is a gigantic show stopper that was part of Obamacare.
The Affordable Care Act requires health insurance issuers to submit data on the proportion of premium revenues spent on clinical services and quality improvement, also known as the Medical Loss Ratio (MLR).

Wow. You don't understand the insurance industry do you? Medical Loss Ratio's have been in use for as long as I have been in the business--so that is more than twenty years. In my state, they have always been used when approving rate increases. The Medicare Supplement market was standardized in the 1990's. MLR's were established at that time and the Medicare supplement market is the most profitable market in the health insurance industry. MLR's have been in place for group insurance throughout my entire career. Most Americans get their health insurance via a group policy that have had required MLR's of eighty percent for as long as I can remember.

Insurance is a pretty sweet gig. It is the only business in the world where you can slap a label on "profit" and call it a "loss reserve" and not have to pay taxes on it. Better yet, you don't even have to pay taxes on any earnings you can get out of that "loss reserve". It is the very reason MLR's are calculated and used by regulators to justify rate increases. Let me explain how it works for most large companies.

First, the company is "self-insured", which--like most names today is very misleading. The company pays an entity to oversee the plan. The company contributes money into the plan and pays for all the health care claims of the employees up to a certain amount, their loss limit. If claims exceed that amount, the insurance company pays it. If they do not exceed that amount, the company gets to keep the excess and call it a "loss reserve". They get to write it off as an expense and yet the money is sitting somewhere EARNING interest TAXFREE.

Now used to be, companies would collect "premiums" from their employees. Turn a profit on the whole insurance bit and build up a cash reserve over years. In the end, the company executives would raid the cash reserve and use that money to take the company private. They paid no taxes on the "profit" from the insurance they "sold" their employees. They paid no taxes on the earnings of those profits. And then, they use the money, funded by the employees to buy the company itself.

Can't do it anymore. The bomb in the ACA was not the use of the MLR. The bomb in the ACA was the ruling that those "reserves" were not the companies money--they belonged to the employees. And now those companies have a fiduciary responsibility to the EMPLOYEES, and they can't take the EMPLOYEE"S money to enrich themselves. And even if they are not self-insured, the ACA requires their provider to rebate to them, not the beneficiaries, any shortfall to the MLR, with the same fiduciary responsibility as a self-insured entity.

Wow and I've been working strictly with Medicare for nearly 20 years also and I understand Federal government requirements Vis-à-vis the
gross misunderstanding of many people and obviously YOU regarding MLR!

AGAIN for you people that don't comprehend...
MLRs are used by state insurance regulators to approve/disapprove insurance premiums.
Historically average MLR has been around 80% of all premiums go towards paying claims.
But the idiots i.e. Gruber who called Americans Stupid for passing ACA evidently didn't know that by jacking the MLR to 85% that
was going to reduce remaining operating revenue by 5%.

And here is the study that proves it!

Because both medical claims and administrative expenses increased more than premiums in 2014, health insurers’ overall operating profits (known as underwriting gain) diminished noticeably from previous years.
This was especially pronounced in the individual market, where the 4.2 percent underwriting loss was three points greater than the underwriting loss two years earlier. Insurers overall showed a small profit margin in 2014 of 1 percent, aided by offsetting gains in the group market, but this was well less than half of the profit margin in prior years.
How Has the Affordable Care Act Affected Health Insurers' Financial Performance?

Finally again think about the concept of "profit"! Evil, profits. BAD profits! And then consider the below charts!
2¢ profit! 13¢ administration costs.. the rest health care claims! Out of every dollar in premium.
View attachment 106532

https://www.quora.com/Obamacare-Rol...es-the-ACA-cap-profits-of-insurance-companies

Come on man. Medicare exclusively for twenty years? Then you know that claim about 15% limit on administrative expenses is horseshit. The entire 15% wouldn't fund your commission on a med sup. And I don't know at what level you are but twenty percent is not enough to fund most of my contracts.

And profit, you damn right you can throw that out the window. It does not bear any resemblance to reality in the insurance business. That little dollar bill graph you got--it shows what happens to each premium dollar. It does not even consider the earnings on those loss reserves. Put another way, what happens to each dollar Blue Cross and Blue Shield EARNED from their loss reserves. Last I heard, BCBS of California had over FOUR BILLION dollars in reserve. Honestly, who do you think owns the office building your office is in, or the mall where you shop. I doubt it is Donald Trump. More than likely, some insurance company holds it in their loss reserves.

Good then let's bankrupt them like your idol Obama wants to do!
Put the insurance companies out of business. Lose $100 BILLION a year in taxes. Let 450,000 people go. Good idea!

 

[healthmyths]

Unbeknownst to a vast majority of people is a gigantic show stopper that was part of Obamacare.
The Affordable Care Act requires health insurance issuers to submit data on the proportion of premium revenues spent on clinical services and quality improvement, also known as the Medical Loss Ratio (MLR).

Wow. You don't understand the insurance industry do you? Medical Loss Ratio's have been in use for as long as I have been in the business--so that is more than twenty years. In my state, they have always been used when approving rate increases. The Medicare Supplement market was standardized in the 1990's. MLR's were established at that time and the Medicare supplement market is the most profitable market in the health insurance industry. MLR's have been in place for group insurance throughout my entire career. Most Americans get their health insurance via a group policy that have had required MLR's of eighty percent for as long as I can remember.

Insurance is a pretty sweet gig. It is the only business in the world where you can slap a label on "profit" and call it a "loss reserve" and not have to pay taxes on it. Better yet, you don't even have to pay taxes on any earnings you can get out of that "loss reserve". It is the very reason MLR's are calculated and used by regulators to justify rate increases. Let me explain how it works for most large companies.

First, the company is "self-insured", which--like most names today is very misleading. The company pays an entity to oversee the plan. The company contributes money into the plan and pays for all the health care claims of the employees up to a certain amount, their loss limit. If claims exceed that amount, the insurance company pays it. If they do not exceed that amount, the company gets to keep the excess and call it a "loss reserve". They get to write it off as an expense and yet the money is sitting somewhere EARNING interest TAXFREE.

Now used to be, companies would collect "premiums" from their employees. Turn a profit on the whole insurance bit and build up a cash reserve over years. In the end, the company executives would raid the cash reserve and use that money to take the company private. They paid no taxes on the "profit" from the insurance they "sold" their employees. They paid no taxes on the earnings of those profits. And then, they use the money, funded by the employees to buy the company itself.

Can't do it anymore. The bomb in the ACA was not the use of the MLR. The bomb in the ACA was the ruling that those "reserves" were not the companies money--they belonged to the employees. And now those companies have a fiduciary responsibility to the EMPLOYEES, and they can't take the EMPLOYEE"S money to enrich themselves. And even if they are not self-insured, the ACA requires their provider to rebate to them, not the beneficiaries, any shortfall to the MLR, with the same fiduciary responsibility as a self-insured entity.

Wow and I've been working strictly with Medicare for nearly 20 years also and I understand Federal government requirements Vis-à-vis the
gross misunderstanding of many people and obviously YOU regarding MLR!

AGAIN for you people that don't comprehend...
MLRs are used by state insurance regulators to approve/disapprove insurance premiums.
Historically average MLR has been around 80% of all premiums go towards paying claims.
But the idiots i.e. Gruber who called Americans Stupid for passing ACA evidently didn't know that by jacking the MLR to 85% that
was going to reduce remaining operating revenue by 5%.

And here is the study that proves it!

Because both medical claims and administrative expenses increased more than premiums in 2014, health insurers’ overall operating profits (known as underwriting gain) diminished noticeably from previous years.
This was especially pronounced in the individual market, where the 4.2 percent underwriting loss was three points greater than the underwriting loss two years earlier. Insurers overall showed a small profit margin in 2014 of 1 percent, aided by offsetting gains in the group market, but this was well less than half of the profit margin in prior years.
How Has the Affordable Care Act Affected Health Insurers' Financial Performance?

Finally again think about the concept of "profit"! Evil, profits. BAD profits! And then consider the below charts!
2¢ profit! 13¢ administration costs.. the rest health care claims! Out of every dollar in premium.
View attachment 106532

https://www.quora.com/Obamacare-Rol...es-the-ACA-cap-profits-of-insurance-companies

Come on man. Medicare exclusively for twenty years? Then you know that claim about 15% limit on administrative expenses is horseshit. The entire 15% wouldn't fund your commission on a med sup. And I don't know at what level you are but twenty percent is not enough to fund most of my contracts.

And profit, you damn right you can throw that out the window. It does not bear any resemblance to reality in the insurance business. That little dollar bill graph you got--it shows what happens to each premium dollar. It does not even consider the earnings on those loss reserves. Put another way, what happens to each dollar Blue Cross and Blue Shield EARNED from their loss reserves. Last I heard, BCBS of California had over FOUR BILLION dollars in reserve. Honestly, who do you think owns the office building your office is in, or the mall where you shop. I doubt it is Donald Trump. More than likely, some insurance company holds it in their loss reserves.

OK... let's assume $4 billion in reserves.
The Net Yield on Invested Assets in 2012 was 4.93%
https://www.treasury.gov/initiatives/fio/reports-and-notices/Documents/FIO Annual Report 2013.pdf
$4 billion times 4.93% equals $197 million! This represented for Blue Shield..

• Year founded: 1939
• Service area: California
• Annual revenue: $13.4 billion
• Membership: 4 million
• Total employees: 6,800
• President and Chief Executive Officer: Paul Markovich
• Blue Shield is a California not-for-profit mutual benefit corporation
• Blue Shield and its affiliates provide health, dental, vision, Medicaid and Medicare health care service plans in California
• National affiliation: Independent Member of the BlueCross BlueShield Association
• Corporate Name: California Physicians' Service
• Blue Shield of California Foundation: Since 2005, Blue Shield has contributed more than $325 million to the Blue Shield of California Foundation to fund nonprofit organizations that help strengthen the health safety net and address and prevent domestic violence
• 2% Pledge: Blue Shield voluntarily caps its net income at 2% of revenue, with approval from the board of directors. More than $560 million has been returned to customers and the community a result of the pledge.

 

[nat4900]

A bit of expose' on HC insurance companies' (and right wingers') hypocrisy......

Republicans in congress want to completely de-fund Planned Parenthood because, although we have the long-standing Hyde Amendment, the claim is made that some federal dollars may pay for abortions.......The rationale? Money is "fungeable".....

Take that same rationale to HC companies and their claim that to allocate 80 to 85% of premiums toward direct services, and see what you get.

 

[BluesLegend]

Is the left ever ashamed by asking other people to pay a portion of their health insurance? Where does it end, should your neighbor pay a portion of your car insurance?

 

[nat4900]

Is the left ever ashamed by asking other people to pay a portion of their health insurance? Where does it end, should your neighbor pay a portion of your car insurance?

Did GWB ask for me to pay for Cheney's oil war in Iraq??