You dismiss 6%, but Wall Street doesn't.
Wendell Potter is former Vice President of corporate communications at CIGNA, one of the United States' largest health insurance companies.
Wendell Potter
The Insurance Industry's Lethal Bottom Line -- and a Solution From Sens. Franken and Rockefeller
There was a time, in the early 1990s, when health insurance companies devoted more than 95 cents out of every premium dollar to paying doctors and hospitals for taking care of their members. No more. Since President Bill Clinton's health reform plan died 15 years ago, the health insurance industry has come to be dominated by a handful of insurance companies that answer to Wall Street investors, and they have changed that basic math. Today, insurers only pay about 81 cents of each premium dollar on actual medical care. The rest is consumed by rising profits, grotesque executive salaries, huge administrative expenses, the cost of weeding out people with pre-existing conditions and claims review designed to wear out patients with denials and disapprovals of the care they need the most.
This equation is known as the medical loss ratio (MLR), an aptly named figure that is widely seen by investors as the most important gauge of an insurance company's current and future profitability. In a private health insurance industry that collected $817 billion this year, a 14 percentage point difference in the MLR represents $112 billion a year! Over 10 years, that would be more than enough to pay for health reform.
Thanks to the efforts of several senators who pushed for a minimum MLR to be included in reform legislation, the current Senate bill requires insurers to provide an annual rebate to each enrollee if non-claims costs exceed 20% in the group market and 25% in the individual market.
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Thank You, UnitedHealth Group. Your Jaw-Dropping Profit Announcement May Be Just What the Doctor Ordered.
The All-Important "Medical Loss Ratio"
During my years as a corporate executive at CIGNA, another one of the big for-profit insurers, one of the things I did was to explain to the financial media why the company's MLR went up or down during a specific period of time. There is constant pressure from investors and Wall Street analysts for insurance company executives to take whatever means are necessary to keep pushing the MLR lower and lower. If they don't succeed, they get punished, often severely, in the stock market. Aetna's stock price once fell more than 20% in a single day after executives disclosed that the company had spent slightly more on medical claims during the most recent quarter than in a previous period. What triggered the "sell" alarm was the company's announcement that its first quarter MLR increased to 79.4% from 77.9% the previous year.
Insurance company executives will never forget the beating that Aetna took that day. Not only did the company's market cap shrink, but so did the stock options held by Aetna's senior executives. The CEO alone lost millions in compensation by reporting an MLR that didn't meet Wall Street's expectations.
Insurance Companies Want to Keep the Champagne Corks Popping
That lesson certainly was not lost on United's executives. One of the main reasons why the company was able to exceed Wall Street's profit expectations for the third quarter that just ended was its ability to push its commercial-segment MLR, which comprises most of its customers, much lower than usual. It dropped a whopping 3.7 percentage points to 80.9%. United, and the other big for-profits, reported even bigger drops during the second quarter of this year. These are the results that bring out the champagne on Wall Street, when you reduce the amount you spend on medical care and make your customers pay more.
Insurers sent their lobbyists across the country to meet personally with the insurance commissioners (and lobbyists are as thick as thieves here in Orlando) because they want the commissioners to give them the slack they need to continue being able to push their MLRs down to what will be a legal minimum next year. The more they can get the commissioners to write the often obscure but critically important rules in their favor -- even if those rules violate the health care reform statute -- the happier it will make Wall Street. That is what is really going on here. It is as simple as that.
The timing of United's embarrassment of riches, however, is causing great concern on Wall Street. Investors and analysts are keeping up with what is going on in Orlando more than anyone except perhaps insurance company executives. They know that the commissioners are expected to complete their work on the MLR regulations Thursday morning and send their recommendations to the Secretary of Health and Human Services, as the law stipulates. In a report Tuesday morning, Carl McDonald of Citigroup Investment Research wrote that United's impressive numbers "couldn't come at a worse time politically. We're at a critical time juncture, as the Health and Human Services Secretary will soon provide final minimum MLR guidance and decide how often to grant MLR waivers. United beating its initial earnings guidance this year by over $1.6 billion pre-tax certainly doesn't help the industry's cause."