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DesideriScuri -> RE: The 8 Ways Obamacare Helps 47 Million Women, Starting August 1, 2012 (8/9/2012 1:57:34 PM)
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ORIGINAL: tazzygirl
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To negotiate better deals, with whom? The hospitals they own? The Congresspeople they own? Who?
Raising the cost of medical care will actually also help out the insurance companies by increasing their medical loss ratios.
Uh huh.. then the smaller insurance companies come running in and scooping up all the business. Not all of them own hospitals.
Aren't these the very same insurance companies that have the most difficult time managing their MLR's?
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Do you have any source I would trust that shows what the average MLR is currently, and how much is spent in premiums? It's nice to know that over $1B will be rebated, but I found a source that $817B was spent on private insurance in 2008. Had premium costs not changed, rebating $1B out of $817B isn't exactly much of a %. 80% of $817B is $653.6B, making a return of $1B a mere 0.112%. That means that insurance companies were at a MLR of 79.888%. That's hardly much at all, even though $1B is a hefty, hefty sum of money.
Doubt anything I would give you would be something you would trust.
http://companyprofiles.healthcare.gov/
PPACA: California MLR Rebates to Average $38.89
The states with average rebates above $500 per family are: Vermont ($807),Oregon ($777) and Indiana ($503) in the large group market; Georgia ($811), Ohio ($783), New York ($632), Alaska ($622), and Illinois ($551) in the small group market; and Mississippi ($651) and Alabama ($582) in the individual market.
Approximately 66.7 million consumers are insured by an insurance company that provides the required value for their premium dollars. This means that a large majority of consumers are insured by companies that meet or exceed the MLR standard: 62% of consumers in the individual market; 83% in the small group market; and 89% in the large group market.
http://www.healthcare.gov/law/resources/reports/mlr-rebates06212012a.html
The goal of the ACA is to bring overhead down to under 20% for individual and small group coverage and under 15% for large group insurance. Considering that other countries keep overhead in the 5 to 10% range, these goals should be easily obtainable.
One argument is what is overhead and what is a health benefit? The NAIC lobbied for the Department of Health and Human Services to include payment of commissions to health insurance agents as a health benefit and not overhead. I know many good health insurance agents, but they sell a product and have never shown any proclivity toward providing healthcare or health education. Thankfully, HHS denied this request.
So what is happening? 2011 was the first year that insurance companies were required to bring down their overhead, unless they were approved for waivers. So what happens if the companies do not meet their overhead target? You get a rebate. The final numbers are yet to be released, but Kaiser Family Foundation estimates that $1.3 billion will be returned back to employers and consumers. Here is the breakdown:
Individual Market – $426 million will be returned to consumers. Approximately 215 plans will provide rebates to 3.4 million people. This averages to almost a third of the individual market receiving rebates. The average rebate will be $127 per person, although some states have much higher averages, such as Alaska at $305 per person.
Small Group Market – $377 million is expected to be returned to employers. 146 plans covering 4.9 million employees will be affected. This is 28% of the small group market and the average rebate will be $76 per enrollee. Plans in Alaska will receive a whopping $517 per person average rebate. I feel sorry for how long the people in Alaska have been overcharged due to inefficiency.
Large Group Market – $541 million will be returned by 125 insurers covering 7.5 million enrollees. As expected, the large group market is much more efficient. This represents 19% of large group enrollees and the average rebate will be only $14 per employee. Vermont wins distinction in this category with an average return of $386 per enrollee.
http://www.forbes.com/sites/carolynmcclanahan/2012/05/15/what-is-a-medical-loss-ratio-the-check-will-be-in-the-mail/
I accept both those links without a problem. Hell, I figured you wouldn't accept the Forbes one. I had read that article, but was looking for more %-ages and total premium numbers to see what KFF's $1.3B (couldn't remember the exact $ amount for my last post, but knew it was at least $1B) rebate report meant. I've seen online articles that stated that employers would be getting the bulk of the rebates, and might rebate the employee some. I would assume that whoever is paying the premiums would be the ones getting the rebates, according to the % of the premium paid.
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