Fri Dec 04, 2009 at 09:46:33 AM PST
Aetna is already planning to kick off over 600,000 Americans who're unprofitable since they get sick and require that claims get paid, right before the health "insurance reform" plan would take effect.
Health insurance giant Aetna is planning to force up to 650,000 clients to drop their coverage next year as it seeks to raise additional revenue to meet profit expectations.
In a third-quarter earnings conference call in late October, officials at Aetna announced that in an effort to improve on a less-than-anticipated profit margin in 2009, they would be raising prices on their consumers in 2010. The insurance giant predicted that the company would subsequently lose between 300,000 and 350,000 members next year from its national account as well as another 300,000 from smaller group accounts.
If you're an Aetna customer, be careful with which claims you submit as that could raise a red flag in their investigative teams. They'll deny your claims, raise your premiums, drop your policy based on some claim of fraud, and give you the ol' administrative runaround in order to discourage you from staying on with Aetna.
slinkerwink's diary :: :: So, please ration your own care! Don't go to the doctor when you need to go because that might be overutilization! Don't go to the family clinic and get your child immunized! Just hold your breath, and keep thinking positively that you'll continue to be well, and maybe you just might wish yourself into a healthy state from that previously unhealthy state.
And why is Aetna doing this? Why would they kick off unhealthy people off their rolls, and people with the potential chance of becoming unhealthy? They want to keep the profits to themselves. And they've done this before in previous years in kicking people off their rolls to jack up their profits.
Aetna is one of the largest insurers in the private market, covering roughly 17.7 million people according to its 2008 annual report. It is also a major player in the current health care debate and inside Washington D.C. The insurance company has spent more than $2 million on lobbying just in 2009, according to the Center for Responsive Politics.
American Medical News, which first reported the story, noted that this is not the first time the insurance giant has cut the rolls in an effort to boost profit margins. "As chronicled in a 2004 article in Health Affairs by health economist James C. Robinson, MD, PhD, Aetna completely overhauled its business between 2000 and 2003, going from 21 million members in 1999 down to 13 million in 2003, but boosting its profit margin from about 4% to higher than 7%."
Will health "insurance reform" stop this practice of private insurance companies in cherry-picking and shunting people off to other insurance companies or onto the public option? No, it won't, because of the weak risk adjustment mechanisms built into the Senate bill and the House bill, which allows these private insurers to game the system.
The Washington Post has weighed in on this issue as well, with several health policy experts quoted about how private insurers would still cherry-pick and game the system:
But simply banning medical discrimination would not necessarily remove it from the equation, economists and health-care analysts say.
If insurers are prohibited from openly rejecting people with preexisting conditions, they could try to cherry-pick through more subtle means. For example, offering free health club memberships tends to attract people who can use the equipment, says Paul Precht, director of policy at the Medicare Rights Center.
Being uncooperative on insurance claims can chase away the chronically ill. For people who have few medical bills, it is less of a factor, said Karen Pollitz, research professor at the Georgetown University Health Policy Institute.
And to avoid patients with costly, complicated medical conditions, health plans could include in their networks relatively few doctors who specialize in treating those conditions, said Mark V. Pauly, professor of health-care management at the University of Pennsylvania's Wharton School.
So, the reforms of the weak risk adjustment mechanisms in the House and Senate bill, rather than being a part of this present health "insurance reform" bill, would likely come after the fact once this bill has been passed. People should be aware that their claims will still be denied, and that they'll face administrative hassles, and likely disincentivized from staying with a certain insurer by being pushed off onto the public option.
Also, that medical loss ratio in the House bill that's often cited as why private insurers would stop cherry-picking? It has a sunset provision that wasn't in the previous House bills as discussed in this article at OpenCongress:
But there’s a twist to all of this. The version of the bill that was passed by the House last weekend includes the provision, but also includes some curious, new "sunset" language. The sunset language states that the new minimum medical loss ratio requirements "shall not apply to health insurance coverage on and after the first date that health insurance coverage is offered through the Health Insurance Exchange." In other words, in 2013, when most of the bill takes effect, the medical loss ratio language would be null and void. There would be no more profit control, just the market competition that is provided by whatever form of the public option is included in the bill. Read the sunset language in context here.
This really doesn’t make a whole lot of sense. What’s the point of including it in the legislation if it’s not going to apply once the bulk of the bill takes effect? Webb wonders if there is some kind of error — either in how he is reading the bill (the same way I read it), or how the language of the bill has been drafted. "In their zeal to get certain protections in place right away they swept Sec 116
which clearly is focused on a future Exchange and tried to enforce its requirements on the current market," Webb writes. This sunset language was not included in the health care bills that went through the three House committees this summer, but it is included in the final version that was passed by the House.
As I've pointed out before,a majority of Americans want the public option because they desperately want an alternative to private insurers, and don't want to be jerked about, denied claims willy-nilly, and dumped off the rolls. They don't trust private insurance companies to do the right thing after health "insurance reform" is passed. The public option itself is more important to these Americans than either the Senate or the House bills because of what it represents---freedom from the abuses of private insurance companies.
Senator Reid is trying to deal away the public option currently in the Senate bill by enabling the conservadems with their hare-brained schemes to put a trigger on the public option such as coming up with Senator Carper's triggered nonpublic nonoption co-op, and Senator Landrieu's new several-year-delayed, triggered, state-based, non-public co-op limited to the exchange option.
continued>>>
http://www.dailykos.com/storyonly/2009/12/4/810785/-This-Is-Why-We-Need-The-Public-Option!
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