A major reason health insurance companies dropping out of Obamacare

[Maryland Patriot]

We'd be wise to go to universal healthcare.

we would be wise to go back to what it was. It was working, I never had any issue at all for my coverage, I paid a premium, I got basically everything covered 100%, no claim was ever turned down and no bills ever showed up in my mailbox for services.
There was nothing at all wrong with the industry, anyone could pay their premium and get coverage, You could shop for the coverage that fit your needs, there were different plans at different rates.
the industry was working perfectly ok. the only thing the ACA did that I would not mind seeing is the ability to keep a child on the plan until they reached the age of 26, this allowed them to complete college without having to worry about insurance premiums on top of everything else. That is the only part that needs to be saved.and if it cant be saved, then I just get a policy for my daughter and pay it until she can cover it herself. Just like everyone else should be doing with their family members.

 

[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?

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

Hey, a good old fashioned BOOOOOOOOOSH post. Now, if you are an able bodied moocher, why is it okay to expect other people to pay your bills? Shouldn't that shame them?

 

[Kosh]

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??

Another far left drone troll debunked religious narrative being run!

 

[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.

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!

What a bunch of hyperbole, and quite disingenuous considering your in the Medicare market. Single payer would not eliminate health insurance. It exists in both Canada and Great Britain. But more significantly, the medicare supplement market operates within the confines of a single payer system, Medicare. Just like the MLR claim--you opened this thread attempting to claim insurance companies were required to spend eighty cents out of every one of their dollars on just health care. And yet you know full well they don't even get eighty cents on the dollar after your commission, let alone any other expense.

I have merely pointed out that within the confines of the insurance industry, profit and loss statements don't mean jackshit. Hell, I have always been taught Insurance companies are happy as hell to break even on the premium dollars they take in and the claims they pay out. They make money holding those premium dollars until claims develop. Especially within the health insurance industry.