85% of the monies taken in from by insurance companies has to go to health

[Maraya1969]

care. If it is not 85% then they must give you the money back that they wasted.

[NightWatcher]

1. says who? is this a proposal?

[Lifelong Protester]

2. Is this not in the current bill?

eom

[babylonsister]

7. Yes! Here...

http://healthcare.nationaljournal.com/2010/02/premium-hikes-and-profits.php

Obama's Health Plan: New Federal Role for Insurance Regulation

snip//

Sebelius pointed to provisions in the House- and Senate-passed health reform bills that would require insurers to spend 80-85 percent of premiums on medical claims.

[Maraya1969]

8. Rachel Maddow on what is going to happen immediately when the bill passes

as long as it does.

[NightWatcher]

11. but it's the job of the insurance co's to pay returns to their stockholders

you cant regulate profits.

There should be NO MIDDLEMAN and NO PROFIT from healthcare. The fire department doesnt take a cut after they put out a fire.

[Maraya1969]

24. NO they have to return it to the insurance buyer that they ripped off.

[SoCalDem]

20. They "maybe" pay out 30% now, so they'll just increase

premiums and or coerce doctors/hospitals to "eat" the rest..

You can fight them, but when you're sick, it's hard enough to muster the energy to fight the illness..

and anyone who thinks the insurance companies will willingly start taking less, might want to offer me some money for this little picture I'm trying to sell:



the folks in France who are keeping it for me will FedEx it to you as soon as I receive your check:)

[Maraya1969]

27. As of 2011 they can only increase your premiums by qualified amounts, no more outrageous

jumps in insurance premiums.

[SoCalDem]

33. they have been quite "pre-emptive" during the last few years..

I won;t cry too many tears for them

I also have no doubt that their legal departments are busily crafting methods for them to stay on the Gravy Train..

[gravity]

35. This is no different than the current incentive structure

Insurance companies will always have the incentive to raise prices higher.

The whole point of healthcare reform is to provide increased regulation to reign in insurance costs despite these incentives.

Under the status quo, insurance companies just have to pay $0 to medical costs for every additional dollar they raise. Under the healthcare bill, they will have to Pay out $6 to medical costs for every additional dollar they can profit from.

[applegrove]

34. Yes. That is wonderful news.

[deaniac21]

3. In your dream world?

[babylonsister]

9. Whose dream world?

http://healthcare.nationaljournal.com/2010/02/premium-hikes-and-profits.php


Obama's Health Plan: New Federal Role for Insurance Regulation

snip//

Sebelius pointed to provisions in the House- and Senate-passed health reform bills that would require insurers to spend 80-85 percent of premiums on medical claims.

[Maraya1969]

12. See this is the way you people are acting against HCF now. You are knee jerk

"NO". You don't even know what is in the bill anymore.

[deaniac21]

54. No one knows what will be in the final bill. The process has been

absolutely transparent though. It will be subject to many changes in the 4 years before it goes into effect since we will have hugh losses in November.

[Hello_Kitty]

4. Who gets to decide what is medical spending and who regulates that? eom

[Maraya1969]

14. I am sure a commission will be set up to regulated it and I bet medical spending

is everything to do with doctors and nurses and hospitals and nothing to do with health care executive's salaries.

[Massacure]

17. I'm curious how the medical loss ratio works.

Are companies allowed to say we are going to distribute 15% of premiums to the shareholders and pay all of the $10/hr employees out of the 85%, or are employee's salaries part of the 15%?

[FrenchieCat]

29. DHHS Secretary

I wrote about this Sec 2718 here: http://www.democraticunderground.com/discuss/duboard.php?az=view_all&address=433x221735

‘‘(a) CLEAR ACCOUNTING FOR COSTS.
It's in the bill, page 7 & 8. Tell me what you find there.
I can say that currently, status quo wise, the accounting determination are
left to 50 different insurance commissioners....but no longer per this bill.
http://democrats.senate.gov/reform/managers-amendment.pdf



And it appears that the determination as to what is health care spending and operating expenses
will be quite stern, as well there will be fees imposed on the insurance industry. In addition, the salaries of management of Insurance companies will be regulated as well.

The language states:

Health Insurance Provider Fee. Imposes an annual, non-deductible fee on the health insurance sector allocated across the industry according to market share. The fee does not apply to companies whose net premiums written are $25 million or less. The fee is $2 billion for 2011, $4 billion for 2012, $7 billion for 2013, $9 billion for years 2014 through 2016 and $10 billion for years after
2016. Creates a limited exemption from the fee for certain non-profit insurers with a medical loss ratio (MLR) of 90 percent or more in the individual, small group and large group markets and whose overall MLR is at least 92 percent.


Limiting Executive Compensation. Limits the deductibility of executive compensation under Section 162(m) for insurance providers if at least 25 percent of the insurance provider’s gross premium income from health business is derived from health insurance plans that meet the minimum creditable coverage requirements. The deduction is limited to $500,000 per taxable year and applies to all officers, employees, directors, and other workers or service providers performing services, for or on behalf of, a covered health insurance provider. This provision is effective beginning in 2013 with respect to services performed after 2009.


I also find interesting that W-2s will require to show the actual amount of the health care premium paid for an employee, therefore allowing Americans to understand how much health care costs.

Reporting Health Coverage Costs on Form W-2: Requires employers to disclose the value of the benefit provided by the employer for each employee’s health insurance coverage on the employee’s annual Form W-2.

The official language as written into the Senate bill timeline can be found here:
http://dpc.senate.gov/healthreformbill/healthbill50.pdf

[Captain Hilts]

5. GREAT motivation to keep prices high! The bigger the pie, the more $ the slice is worth. nt

[ihavenobias]

10. Bingo. Healthcare consultant RJ Eskow made this very point.

Video: http://www.youtube.com/watch?v=-_oVK7iXkgo

Article on HC reform: http://www.huffingtonpost.com/rj-eskow/the-health-bill-the-price_b_398207.html

Keep in mind some of this info no longer applies, but most of it still does with the current bill.

[Maraya1969]

36. What part applies. This was written in 2009

[ihavenobias]

38. I posted the article as a courtesy to those with slow connections.

The video interview is more relevant. As to what part applies, I specifically referred to the issue of trying to mandate that a certain percentage of each dollar is spent on care.

[NYC_SKP]

15. It's a damn good thing we aren't holding them to 99%, or it would cost us Brazillians!!!!

touche, your counterpoint.

indeed, not for profit is the way to go, but since for now we got em, we gotta set some limits.

[gravity]

16. That is some backwards logic

It is implying that if we deregulate the profits for insurance companies, prices will go down.

[Captain Hilts]

46. No. It's saying there is still no motivation to keep prices low. nt

[FormerDittoHead]

26. Like a Realtor - it's either price or turnover...

The higher the price the higher commission.

But Realtors know the value of turnover as well. Better to sell 2 houses quickly for not-so-much each than hang on to 1 hoping for someone to bite.

So consider what I heard on the radio (NPR) when a doctor called in trying to address one of the reasons why things cost so much.

A patient came in with a problem with their knee. Forgive me, I don't know medicine, but the injury was more specifically given by the doctor.

The doctor described how they know that it would need an MRI to see the detail in the soft tissue. She went on to say that she then found herself in this discussion with a person from the insurance company (it was in Philly, so it had to be BC/BS, because they're like 90% of the "free" market here) who was NOT a doctor, reading out of some written policy, that first, they would cover an ultrasound, then an Xray, and only then if the problem wasn't discovered an MRI.

But the doctor explained how not only would the first two procedures be inconclusive, it would delay the eventual MRI by 6-10 weeks, and in that time the problem would get worse.

What I'm saying here is that by keeping the insurance companies DIRECTLY IN CHARGE OF OUR TREATMENTS we won't be SOLVING THE PROBLEM OF COSTS.

[Captain Hilts]

47. BINGO. nt

[Maraya1969]

39. Are you saying that the insurance companies determine how much

an MRI costs? Because I can tell you that doctor's do. I know this because a relative was head of a department and had to report another doctor for ordering many more MRI's than was necessary to help pay for his new house.

One of the reasons we get so many tests is the doctor needs to pay for the equipment.

If an insurance company benefits from how much the medical costs are then why do they cut people off who have pre-existing conditions? You would think they wanted them around so they could make so much more money.

[JVS]

42. Insurance companies negotiate prices, now they'll have little incentive to negotiate well.

[Captain Hilts]

48. So long as your income is determined by percentages, it's best to keep prices high. nt

[JVS]

40. exactly

[NYC_SKP]

6. Are you watching Rachel, is that where you got this? She was talking about Medicare, IIRC.

I'm pretty sure about about this.

If I'm wrong, please get us a link!

:P

[babylonsister]

13. See post #7. nt

[Maraya1969]

21. Within 90 within health reform passing - nothing to do with medicare

And I'm not using a link I am watching a re-run of it on TiVo. I'm sure the link will be up as soon as the people who know how to do such things do it.


And if they want to raise your rates they have to come up with a reason why or they can't raise them - starting 2011

[NYC_SKP]

25. I love how she broke it down, what happens in six months, next year, etc.

I'm very excited and pleased about the whole thing.

I know it's just a start, but it's a start I wasn't sure I'd live to see.

[Bluebear]

18. Super. The incentive, then, will be to keep prices escalated for more $$$

[gravity]

22. Because currently the insurance industry has no incentive to raise prices

[slipslidingaway]

19. And in the early 90's it was 95% according to Wendell Potter, we've come

a long way.

:(

[Maraya1969]

23. I hope the 3 people who just un'recd this are troll. God help us all if they are "Democrats"

[slipslidingaway]

28. Did you see Wendell Potter on this subject. n/t

[FrenchieCat]

30. I just rec'ed. You're back to +1 for now!

:hi:

Some folks don't want anyone informed.
Almost like the Texas Board of Education.

[upi402]

32. It was 95% in the 90's and should be

96 to 97%.

85% Like getting a kiss after getting used and abused -imho. But it's like Stockholm syndrom for all of us and I'm glad the sickest of evils will be addressed by the time 4 years is up.

[FrenchieCat]

41. It's 65/35 now.....

so your posts shows exactly that this bill takes things back in the right direction....
which is the direction we are interested in going in.
So in fact, you are proving an important point.
No one is saying that this bill is a panacea,
but it is going in a progressive direction.

You glass is 1/2 empty....mine is 1/2 full.

[slipslidingaway]

43. That is not across every market. n/t

[Oregone]

31. Creates a wonderful incentive to negotiate higher rates and demand higher premiums

[slipslidingaway]

37. Wendell Potter video and more ...

http://journals.democraticunderground.com/slipslidingaway/310


"...Let’s get right to it. Section 2718 of the Senate bill provides that...

Health insurance companies will be required to report publicly the percentage of total premium revenue that is expended on clinical services, and quality rather than administrative costs. Health insurance companies will be required to refund each enrollee by the amount by which premium revenue expended by the health insurer for non-claims costs exceeds 20 percent in the group market and 25 percent in the individual market. The requirement to provide a refund expires on December 31, 2013, but the requirement to report percentages continues.(1)


Talk about “refunds” to patients sounds good at first, but what the Senate is really saying here is that the Senate bill requires private insurers to spend only 75 to 80 percent of every premium dollar on actual health care. OK, so what does that mean?

Let’s put it another way: the Senate bill authorizes private insurers to consume 20 to 25 percent of every premium dollar on administrative costs.

But according to the Senate’s own data, ordinary Medicare's administrative costs are only 2%.(2) In other words, if we simply opened ordinary Medicare to uninsured Americans, 98 cents of every Medicare dollar would buy actual health care..."

[happy_liberal]

44. if we simply opened ordinary Medicare to uninsured Americans,

98 cents of every Medicare dollar would buy actual health care..."


why was it we didn't do that again?

[slipslidingaway]

52. There is only one reason - to protect the corporations and their investors :( n/t

[mdmc]

45. what counts as health care?

lobbying for health care? CEO salaries?

[MadHound]

49. That's a nice blanket statement,

Except I guarantee you that right now an army of lawyers are already figuring out ways to get around that, and that 85% figure will become nothing more than a meaningless statistic.

[Vinca]

50. That's an overall number, right?

It's not like an individual pays them $10,000 and insurance pays $100 for medical bills and then insurance refunds some money. The 85% is overall and could include all kinds of things that could be related to health care. Training sessions on a cruise ship, for example. Besides that, who is going to be keeping tabs on them?

[boston bean]

51. They can just raise the cost of insuring you. Jesus Christ are people that dumb

[Lydia Leftcoast]

53. In other words, they have explicit permission to guarantee profits

Gee, I wish someone would do that for my business.

[slipslidingaway]

55. Yes, 20% for individual policies and 15% for group policies - nice! :( n/t