Massive corporate giveaway?

[ProSense]

• making it illegal for insurers to drop anyone based on a pre-existing condition
  
  
• including a public option (House)
  
  
• including a plan adminstered by the OPM (Senate)
  
  
• increasing the MLR to 80/85 percent
  
  
• expanding Medicaid
  
  
• improving Medicare
  
  
• funding community health centers

How does any of that constitute a massive corporate give away?

[Cha]

1. Not looking at the whole picture when

that soundbyte is propagated.

[Fire1]

37. Not giving a damn, either way. It's tantrum time and the

all or nothing brigade is still trying to hang on. It's sickening. Absolutely sickening.

[Larkspur]

2. There will be no public option offered and the subsidies will be going to feed those greedy

corporations. They may not be able to explicitly drop you if you have pre-existing conditions, but there is little in the bills to control costs. Also the insurance industry lobbyists wrote a large chunk of the senate bill, which is the one Obama supports.

There is also a section in the bills regarding "fraud" by customers. The insurance companies can use that "fraud" claim to drop you from their plans.

The other unknown is how thoroughly will the regulations be enforced. In California there is an anti-recission law, but recently. One of the large insurance companies broke that law, but the state decided not to take it to court to get the million dollar fine because they found themselves outgunned by the companies lawyers.

If our government can't afford to enforce the regulations because they will be outgunned by the army of lawyers for the insurance companies, then those regulations are meaningless and the insurance companies will break all those laws they find inconvenient with impunity. That will translate into higher premiums for everyone.

[ProSense]

3. "the subsidies will be going to feed those greedy"

Why is it okay to kill the bill, preserving the current MLR and 150 million people whose premiums "feed those greedy corporations," but not OK to pass a bill that reduces how much of everyone's money, including the currently insured, goes to the greedy corporations?

Why is it okay to kill the bill to keep 30 million, including the 15 million who will be added to the Medicaid rolls, uninsured?

[Larkspur]

7. I didn't say not to pass the bill, but

I don't look upon it as a great success because it subsidizes an already corrupt system that will get worse, and the insurance companies already know where the loopholes are.

I also don't think these bills tell what the insurance companies have to offer in their plans, so they could offer threadbare plans and force you to purchase extras to cover your pre-existing conditions that will raise your costs.

And since the anti-trust exemption was not removed, the health insurance companies can still collude on setting prices and coverages.

The other thing about the senate bill is that it will allow the insurance companies to charge people, like older people who aren't eligible for Medicare as well as overweight or anyone with certain conditions up to 3 times what the standard premium is, so price gouging will still go on, but it will be under a different name.

This bill is also not really a universal coverage bill since it only covers 30 out of 47 million people.

[ProSense]

8. "I don't look upon it as a great success because it subsidizes an already corrupt system" No

that statement presumes that the bill is only subsidies with no other reforms.

[Larkspur]

10. The so called reforms are only as good as the enforcement of them

A Republican controlled Congress will work to weaken this bill, not make it stronger. A Republican controlled White House may not enforce the regulations so the People will be screwed again.

[ProSense]

13. "A Republican controlled Congress will work to weaken this bill"

So your opposition to the bill is doubt about enforcement and fear that it will be weakened in the future?

[Larkspur]

30. Yes and the fact that the pre-existing conditions stuff doesn't take affect unto 2013 or 2014

but the taxes start in 2010.

And not only will Republicans work to weaken it, the ConservaDems who are a owned by the health insurance industry will work with republicans to weaken regulations that would help ordinary people.

[SpartanDem]

33. The taxes don't start in 2010

and if bill shouldn't passed becuase the GOP might try to weaken it then what is the point of trying to increaase regulation anyything. Hell we just shouldn't try to put Dems office becuase the GOP will just undo what we do.

[brentspeak]

15. The previous poster demolished your claim that the bill is not a corporate giveaway

[jtrockville]

4. Insurers will create ways around these provisions. Count on it.

Characterizations like "pre-existing condition" don't even exist in civilized/developed nations. We'll see a plethora of new characterizations designed to screw us in ways we can't even imagine. Remember, the mandate of an insurance company (or any company) is to maximize profit, not to provide goods/services.

Oh, and a mandate to purchase this SCAM OF A PRODUCT is why this so-called "reform" can be better classified as a "corporate giveaway".

[johnaries]

6. "maximize profit". That's what the MLR restriction is for.

Only 15% will be allowed for administrative costs and profits. Anything more is rebated to the consumer.

[Larkspur]

12. If the health insurance industry didn't think they could get around this

then Wall Street would not be bumping up their stock prices now.

I look for MLR to be weakened by ConservaDems and Republicans in the future.

[Hello_Kitty]

16. Yeah right.

All the MLR ratio does in enable insurers and providers to act like "cost plus" defense contractors. They know that they will make %15 profit no matter what. And 15% of a $200 aspirin is a helluva lot more than 15% of a 20 cent one. You're not going to get jack squat rebated to you.

[bornskeptic]

74. Health insurance company profits are in the vicinity of 3% or 4%, not 15%.

http://seekingalpha.com/article/155858-health-insurance-industry-s-profit-margins-rank-86

A high price for aspirin is not beneficial for the insurer-just the opposite. A lower cost per aspirin means a reduction of medical loss, and hence more dollars remain to go into profit.

[jtrockville]

18. They'll change the definition of MLR.

Or include additional items in what is considered "medical". Count on it.

[Hello_Kitty]

20. Junkets to Barbados will be included in the MLR if they're for "training"

Bet on it.

[jtrockville]

22. As will the newly purchased private Leer to transport them.

The numerous ways around these "regulations" are so transparent, I can't believe we even need to point it out.

[SpartanDem]

34. It will the be government defining MLR not the insurance companies

[jgraz]

35. The MLR restriction is a HUGE incentive to raise rates

There are no direct limits on the rates these parasites can charge, so anytime their CEO's bonus schedule doesn't fit under the current 15% restriction, they just bump your policy price by a few %%. It's a ridiculous giveaway to people who already have far more than any twenty people would need.

[Milo_Bloom]

69. LMAO!!!

CLaims administration becomes "Care Administrator" and it suddenly doesn't count in the 85%


The cheerleaders are so easily fooled with this bill.

[phleshdef]

53. Oh well, guess we have to ban insurance companies from existing then.

Because THATS SO REALISTIC!!

[burning rain]

68. Health insurance companies will still be able to deny treatments/procedures...

by disputing their medical necessity, for example, although they won't be able to deny you coverage based on a precondition, or a treatment simply because you've run into the cap. A useful reform here would be to forbid insurance companies from denying doctor-ordered treatments, as Dutch law does.

[TheKentuckian]

70. Create? The exceptions and loopholes they need are there now

Plus, there is nothing being established to actually oversee and enforce.

The more people keep trying to sell this turkey and pretend dogshit is pumpkin pir the more I move toward killin it.

[johnaries]

5. And don't forget

>No raise in premiums when you get sick

>Cannot deny coverage for any reason, period (including pre-existing conditions)

>Limiting deductibles and out-of-pockets

>No co-pays for preventative care

>Eliminating Lifetime Limits

>Any increase in Premiums must be reviewed by HHS in conjunction with the States

>Emphasis on results-oriented care

[Larkspur]

9. They are only as good as how strong they will be enforced

I won't be surprised if health insurance companies outman the government in the courts as well as in contributions to legislators, who will work to weaken the regulations to the point that they are a joke. That's what a Republican controlled Congress would do. They won't repeal health care but they can sure deregulate it to the point that we are back where we started before this bill was passed.

[jtrockville]

19. AND they're only good if the penalty for violating is higher than

what it would cost to follow the rules. We can count on insurers breaking these rules. We can count on non-enforcement or very low penalties - either way we still get screwed.

Insurance is a SCAM. No amount of regulation will change that.

[freddie mertz]

11. Yes, basically. That is what the mandate is.

And we are by no means assured of a public option in the final bill.

[Hello_Kitty]

14. The part where people are forced to buy a product from a private corporation

One that is exempt from antitrust regulations, no less.

That's what constitutes a massive corporate giveaway. But you knew that.

[ProSense]

17. "That's what constitutes a massive corporate giveaway. " No

mandates do not constitute a massive corporate give away. If you can show how the insurer are going to benefit massively from having their profit margins reduced while having to serve more people, please do.

[jtrockville]

21. Here's ONE way (I'm sure insurers will find MANY more)

Executive compensation isn't profit, it's an expense. Insurers need only to classify executive compensation as a "medical expense". There will be a loophole for this. Count on it.

[ProSense]

23. Not likely.

"Executive compensation isn't profit, it's an expense. Insurers need only to classify executive compensation as a 'medical expense.'"

What does this have to do with the MLR? By your logic, why isn't that being done now?

In fact, the CBO stated that a 90 percent MLR would effectively make a government program. The bill proposes an MLR of 85 percent. That's significant.

[Hello_Kitty]

24. We only need to look to defense contractors as the model

For what a crackin' good value this is going to be to the American public. :eyes:

[ProSense]

25. Or we could look at apples:

Medicare, Medicaid and the Federal Employees Health Benefits Program.

[Hello_Kitty]

26. FEHBP maybe, but hell no on Medicare and Medicaid

Not even fucking close, ProSense.

[ProSense]

28. Medicaid

About 15 million of the projected 30 million who will gain coverage will be added to the Medicaid rolls, which makes it very relevant.

[Hello_Kitty]

29. Relevant to what?

You're moving goalposts again ProSense.

[jtrockville]

27. I don't trust MLR one bit. It can be fudged.

Insurers will find ways to stay fat, be it profits or compensation. I feel certain that CBO doesn't use the same accounting rules as the insurers. If I'm wrong and they do now, insurers will quickly change to a non-GAAP to calculate the ratio, which will promptly become generally accepted as soon as they implementation it.

Insurance will continue to be a SCAM. It's the problem, not the solution.

[jgraz]

36. Yep. Not making enough profit? Just raise your rates.

The 15% limit is no limit, since rates are not capped one bit.

[SpartanDem]

38. If they're not spending that money on medical care they can't keep it

if puts them under 85%. If you jack up your rates and end up spending only 82% that 3% must be given back.

[jgraz]

39. You don't understand. 15% of *more* == *more*

Raise the rates, you get more profit. Not happy with your 15% of 1 billion in revenue? Raise your rates 30% and you're making 15% of 1.3 billion. Easy peasy.

[ProSense]

41. You don't understand

there is a cap on premiums, and high-cost plans are taxed. In addition, there is another $102 billion in taxes on insurance and drug companies.

Edited to add:

The largest element of the financing of the House plan is a surtax on high income taxpayers (raising $460 billion over 10 years), a proposal not included in the Senate bill. The Senate plan, in turn, includes two proposals not in the House bill – an increase in the Medicare payroll tax for high income workers (producing $54 billion), and a new tax on high-premium employer-sponsored health plans (raising $149 billion). Both proposals contain new excise taxes on various health industries, though the scope of the taxes varies – the House taxes only medical device makers (for revenues of $20 billion), while the Senate bill also includes taxes on brand-name drug companies and health insurers (for total revenue of $102 billion).

A major financing component of both proposals is a reduction (relative to current law) in federal spending on existing health programs such as Medicare and Medicaid ($456 billion in the House and $491 billion in the Senate). The savings, which come primarily from Medicare changes, are net amounts, reflecting changes in the programs that increase costs as well (though not increased eligibility for Medicaid, which is accounted for under the cost of expanded coverage). The House bill, for example, includes increased payments to primary care providers in Medicaid at a cost of $57 billon over 10 years.

PDF

[freddie mertz]

45. Right. Middle-class HC benefits are taxed, in violation of Obama's campaign promise.

This is Republican policy, part of McCain's campaign, which Obama ran AGAINST for good reasons.

I supported him on it back then, but he let me and all the rest of us down, breaking his "if you like the coverage you have, you can keep it" promise in the bargain.

Try and spin that.

[ProSense]

49. Wrong

The Truth on Health Care Reform and Taxes

Second, the excise tax levied on insurance companies for high-premium plans, the so-called "Cadillac tax," will affect only a small portion of the very highest cost health plans – a total of 3% of premiums in 2013. The vast majority of health plans fall below the thresholds set in the Senate plan and would be completely unaffected by the provision. And those that are above the threshold would only face an excise tax on the generally small portion of the plan that exceeds the threshold. As a result, based on analyses by the Joint Committee on Taxation, only about 3% of premiums will be affected by this provision in 2013. In addition, the Senate plan provides special protections to plans held by workers in high-risk professions – like police and firefighters – as well as by those over 55.

[freddie mertz]

52. I read the whole link (at the White House, no less)

And am unconvinced, utterly, by their efforts to minimize the impact, which, by the way, only talks about ONE YEAR.

In the end, the problem with your source is that I just cant trust that source anymore.

I explained why in the previous post.

Fool me once, as they say....

[jgraz]

50. Really? There's a cap? What's the amount?

Is it monthly? Yearly? Does it require some sort of minimum coverage?

(Hint #1: a GOP-inspired, middle-class tax on high-priced insurance is not a "cap".)

(Hint #2: There is no cap. Don't bother looking for it.)

[SpartanDem]

54. Yes there is a cap

out of pocket expenses are hard capped it's based on current HSA limits so for this year it's 5,950 individual and 11,900 for family. This includes both deductibles and co-pays and it moves lower based on income.

Sec. 1402. Reduced cost-sharing for individuals enrolling in qualified health plans. The standard out-of-pocket maximum limits ($5,950 for individuals and $11,900 for families) would be reduced to one-third for those between 100-200 percent of poverty, one-half for those between 200-300 percent of poverty, and to two-thirds for those between 300-400 percent of poverty. The plan’s share of total allowed costs of benefits would be increased to 90 percent for those between 100-150 percent of poverty (i.e., the individual’s liability is limited to 10 percent on average) and to 80 percent for those between 150-200 percent of poverty (i.e., the individual’s liability is limited to 20 percent on average). The cost-sharing assistance does not take into account benefits mandated by States.

Premiums are capped as percentage of income.

Sec. 36B. Refundable credit for coverage under a qualified health plan. The premium assistance credit amount is calculated on sliding scale starting at two percent of income for those at or above 100 percent of poverty and phasing out to 9.8 percent of income for those at 400 percent of poverty. The reference premium is the second lowest cost silver plan available in the individual market in the rating area in which the taxpayer resides. The premium assistance credits do not take into account benefits mandated by States. Employees offered coverage by an employer under which the plan’s share of the total allowed costs of benefits provided under the plan is less than 60 percent of such costs or the premium exceeds 9.8 percent of the employee’s income are eligible for the premium assistance credit. This section also provides for reconciliation of the premium assistance credit amount at the end of the taxable year and for a study on the affordability of health insurance coverage by the Comptroller General.

http://dpc.senate.gov/healthreformbill/healthbill05.pdf

[jgraz]

57. Neither of those is a premium cap.

1402 describes co-pays and deductibles. It says nothing about the premium rate which must be paid on top of these out-of-pocket expenses.

36B describes the tax-credit paid by US to the insurance parasites in support of those who cannot afford whatever premiums they choose to demand. The insurance parasites still get the money -- it just comes from a different source.

[ProSense]

62. Dumb!

Employees pay a percentage of their premiums. You assume employers are going to begin paying a higher percentage on demand by the insurance companies. That's absurd. A cap on out-of-pocket is a cap on premiums.

[jgraz]

71. Is this a new warning label on your posts? Might I suggest "Really Dumb"?

Just so we know what to expect. Though, in truth, just seeing your username is enough.

No, "out-of-pocket expenses" means co-pays and deductibles, not premiums. Here's the CBO report, which makes it clear that premiums and out-of-pocket expenses are two different things. http://cbo.gov/ftpdocs/107xx/doc10781/11-30-Premiums.pdf

A little tap from the clue-stick, just for you.

[SpartanDem]

43. MLR has nothing to do with revenue

it not about the company getting 15% of their revenue. It is based the amount premiums they take in and the amount claims they pay out and administrative expenses they have.

[jgraz]

47. Do you understand what "revenue" means?

From your last reply, it seems you don't.

[SpartanDem]

51. Yes I understand the term

If a company raises it's rates 30% it must have a correspoding increase in the claims it pays out.

[jgraz]

56. Yes, and what happens to their profits?

Do they increase or decrease?

[SpartanDem]

64. They would increase

but the point remains they could not raise rates without an matching increase in premiums used for mediccal care.

[jgraz]

72. Easily done if you own a few hospitals.

Aside from the HUGE loopholes allowing insurance companies to re-classify employees as "care providers", the MLR almost seems designed to place upward pressure on health costs.

[niceypoo]

31. Privatizing universal healthcare and institutionalizing the insurance companies that caused...

...the problem in the first place.

[Armstead]

32. There wikll be no public option but people will be forced to buy private insurance.

Sounds like a corporate giveaway to me.

Yes there are some strings attached, but I doubt between the millions of new young healthy captive customers, the subsidies (i.e,. taxpayer money going to the insurers on top of fees) and very little regulation of rates, I doubt the insurabnce companies are crying in their beer.

[Milo_Bloom]

40. Yes, massive corporate giveaway.

"making it illegal for insurers to drop anyone based on a pre-existing condition"

But, they can cap benefits AND can drop you for any other number of reasons. In the same way that a law saying you can't discriminate against people based on race didn't stop people from discriminating against people based on race, this will NOT stop insurance companies for refusing insurance to those with pre-existing conditions, it will just change the lingo.

"including a public option (House)"

We all know this is dead and gone.

"including a plan adminstered by the OPM (Senate)"

Sold by the corporations. Aka, massive corporate giveway.

"increasing the MLR to 80/85 percent"

Change a few job titles and you get right around this restriction. (Administration becomes, quality/care inspector)

"expanding Medicaid
improving Medicare
funding community health centers "

At what cost?

[ProSense]

44. "But, they can cap benefits AND can drop you for any other number of reasons. " Nonsense

"In the same way that a law saying you can't discriminate against people based on race didn't stop people from discriminating against people based on race"

What a ridiculous analogy.

[Milo_Bloom]

46. It is reality, however.

There is nothing in this bill saying that there is NO REASON they can refuse you insurance. You still have to apply, you still have to be "approved".. the only thing they can't do is use "pre-existing condition" as the excuse anymore.

The stupidity and apologizing floating around this bill is absolutely an incredible thing to behold.

[ProSense]

55. "There is nothing in this bill saying that there is NO REASON they can refuse you insurance."

It's illegal.

"The stupidity and apologizing floating around this bill is absolutely an incredible thing to behold."

The spin trying to justify bullshit outcomes, with everything from "watch" to speculation that the insurance companies will get around laws, is what's stupid.

[Armstead]

59. No, what is poor planning is to ignore potential bad consequences

It is
But it is also possible that they will continue to act like sharks and do whatever they can to circumvent the purpose of the bill.

It's kind of like when banking was deregulated, and the DLC was saying "Well we're not going to see many abuses of this, and there will still be a robust and diverse financil system."


Sometimes the Emperor really doesn't have any clothing.

[Milo_Bloom]

65. You couldn't be more wrong.

Nothing illegal about it. Nothing in the bill to stop it.

It's a shame you just don't read the bills, instead of listening to the spin.

[freddie mertz]

42. How about a "massive, mandated, under-regulated privatization scheme"?

Which, in the Senate bill, includes no public pan and is financed by taxes on the middle class.

As I said in the other "Excuse for bad legislation" thread: That about sums it up for me.

[dave29]

48. Giveaway implies nothing received in return

which most of the responders in this thread can't seem to wrap their heads around. However, they weren't going to like it anyways... so, good luck with those who can't see beyond the "bad" in this bill, and would prefer giving folks who would be helped the finger.

I'd challenge all those complaining of loopholes in the bill to stop using them in their arguments.

[Armstead]

60. The likely use of loopholes by insurers is part of the point

Ignore them at your peril.

Frankly, I would prefer that in time we naysayers are proven wrong, and we see great improvements in accesss and affordability.

However, if we are correct (or even partly correct) and the worst happens, don't be coming back saying "This isn't quite what we had in mind."

[dave29]

66. The bill is already not quite what we had in mind.

I wanted a robust public option, for example, if not single payer. I am willing to see there is still good in this bill for millions... if not myself.

[Armstead]

73. I am simply saying that people ought not attack those who say...

that the way this bill is structured leaves the door open to unforeseen consequences, even with the good stuff.

Maybe all will be warm and wonderful. But just as many warned about things like NAFTA and bank deregulation, people should acknowledge that there are risks in this that may be cause for regret later.

[Kurt_and_Hunter]

63. What is the return on the profit?

Of course something is gotten in return, so it's not 100% give-away.

The additional profit component is, however, a give-away unless you believe that it is necessary to the most efficient and/or quality way of getting the job done.

If private insurers can do this so much better than the government that it is worth the increased profit component of the program then so be it.

If, however, the government could do a good job of it then preventing the government from doing so and rather steering the business, by law, to private insurance is indeed a needless give-away of the additional profits generated by the policy.

[dave29]

67. of course we don't like it... it's the best we could get.

Please write to everyone in Nebraska and Connecticut and see if we can do better next time.

[Kurt_and_Hunter]

58. Serious question: Why are insurer's stock prices up so much?

I agree that the corporate give-away language is probably too strong, but the expectation (by people whose business is analyzing the $$$ implications of things like legislation) is that insurance company profits will increase a decent amount going forward.

It's a fair question.

[dave29]

61. because stock prices are based on speculation and perception

it probably is actually helping insurance companies stock prices that those who are screaming about the bill the loudest are those whom are inferring this will be a windfall. Beyond that, the overall market is up almost 20% for the year, and that is almost across the board. Like all things what goes up must come down. So two further points:

1) Wishing these companies not to do well may hurt anyone you know who is unknowingly invested inthese stocks via a 401k plan, IRA or some other mutual fund type arrangement.
2) The fact is, hurting these companies is not necessarily the goal. Improving their services, the amount spent on healthcare, getting many more folks insured, and much tighter regulation is what much of this reform is about.