Obama Administration loosens medical-loss ratio rules for "mini-med" health insurance policies!

[Better Believe It]

Rules Eased for Some Health Plans
By JANET ADAMY And AVERY JOHNSON
November 23, 2010

WASHINGTON—Amid pressure from employers, the Obama administration on Monday loosened rules for bare-bones health-insurance policies. It marks one of the administration's biggest steps to peel back regulations that big business found onerous under the health- care overhaul.

McDonald's Corp. had warned regulators it might have to drop its health-insurance plans for 30,000 hourly workers unless it got an exemption for these policies, which have low premiums but also limit payments for medical costs.

The rules, codifying language in the health law, say insurers will be required to spend between 80% for smaller carriers and 85% for larger carriers of their revenue on medical care, a calculation known as a medical-loss ratio. That limits how much they put toward salaries, profit and other nonmedical costs.

Providers of "mini-med" policies, like McDonalds, which caps benefits at a low level, had objected that they would have trouble meeting those levels, in part because they have high administrative costs.

The basic McDonald's plan for newer store workers now charges a single employee $13.09 a week for a plan that tops out at $2,000 a year in benefit payments.

Democrats said eliminating plans with such limited coverage was the reason they passed the law in the first place.

Read the full article at:

http://online.wsj.com/article/SB10001424052748703559504575631100731134106.html?mod=WSJ_hp_LEFTWhatsNewsCollection

[rocktivity]

1. Consider the source.

I'll wait until this turns up in a real publication, thank you.

x(
rocktivity

[Better Believe It]

5. I'll wait until I see your evidence this is not true before I dismiss it.

Can you refute it?

[rocktivity]

7. It's not the story I'm doubting

it's the Murdoch spin.

:headbang:
rocktivity

[Shrek]

45. Timothy Noah has an article about it in Slate

http://www.slate.com/id/2275877/

[Eric J in MN]

2. The article says that in 2014, low-wage workers will be using subsidies...

...to buy insurance on an exchange, anyway.

[Lucky 13]

4. So between 2010 and 2014 what are they supposed to do?

Hang on? Hope that nasty infection takes care of itself?

[Eric J in MN]

9. They will have the same coverage from McDonald's as if the HCR bill

...hadn't passed between now and 2014.

[Lucky 13]

11. You want to tell me what the point of passing a health care bill was..

... if we were just going to exempt companies from it?

[Eric J in MN]

14. To get health insurance to 30 million more people, starting in 2014.

They're granting exemptions because the subsidies which start in 2014 aren't available yet.

[Lucky 13]

15. No subsidies are even guaranteed! With a now republican House, you think that's gonna happen?

[BzaDem]

17. Actually, they are guaranteed unless Republicans can override Obama's veto. n/t

[Lucky 13]

21. Correct me if I'm wrong... seriously...

Subsidies amounts weren't specified in the legislation and are subject to change. Funding of the programs in the legislation will be at the discretion of the budgetary process through congress.

Seriously I'm not being a smart ass with you... educate me if I'm wrong.

[BzaDem]

22. Subsidy amounts were specified directly in the legislation, and are not subject to the

budgetary process. You are thinking of discretionary spending (which is subject to the budgetary process), but the subsidy amounts are mandatory spending which are not subject to any budgetary process. It is similar to Social Security and Medicare, in that the spending occurs whether or not Congress likes it.

The only way for Congress to defund the subsidies (or SS, or Medicare, etc) is for them to pass a bill signed by the President.

[Eric J in MN]

18. We have a chance to take back the House in 2012. NT

NT

[Lucky 13]

20. ROFL!!!!!

Oh really? Why? Because we did such a fucking bang up job of that last month??

:rofl:

[BzaDem]

23. .. because a Presidential electorate with 60% turnout is different than a midterm election with 40%?

I personally don't think we will take back the House in 2012, mainly because of redistricting. But the idea that the election results in 2012 will simply follow 2010 is silly.

[mzmolly]

26. What they're doing now. They'll also get a rebate. "You want to tell me "

why those who promoted a kill the bill approach, are complaining about it taking a couple years to implement? C'mon.

[Lucky 13]

39. Who promoted a kill the bill approach? Certainly not me.

Though I did and still do wish less deference had been given to corporations and insurers.

My main point is we enacted these laws for a reason. There are certain elements that are in effect starting NOW... and we are exempting multi-trillion dollar corporations from implementing them!!! McDonalds does not "need more time" to get this done. It's bullshit.

[Better Believe It]

8. How much money for subsidies are guaranteed under the law? Answer. None.

Not without Congress voting for the funds.

Congress will be cutting "deficits" not adding to them with massive appropriations for new "entitlement" programs.

[BzaDem]

19. That is not true. The subsidies are mandatory spending. No annual funding bill is required.

This is not money that is appropriated every year -- it is mandatory spending (like Social Security/Food stamps/Medicare is mandatory spending).

As usual, every post of yours about HCR is premised on a factual error.

[Better Believe It]

24. Exactly how much money is guaranteed? Specifics and credible links please.

Not just assertions.

Thank you.

[BzaDem]

30. Subsidies are calculated on a sliding scale. Here's a link to a subsidy calculator.

http://healthreform.kff.org/SubsidyCalculator.aspx

[Better Believe It]

35. The calculator fails to answer any of the big questions! Once again:

How much will insurance premiums be, exactly what benefits are covered under those premiums and how much are the co-pays and deductibles?

And the numbers provided at your link are mere estimates and don't even cover insurance coverage provided by employers!

So I suppose we can guess the answers to all of the above questions and just throw numbers around willy, nilly without any idea of what insurance will cost, what it will cover and it appears we won't even get actual subsidies, just some tax credits AFTER we've paid out hard cash for the policies!

If you can come up with some solid, verifiable numbers please post them.

Thanks again.

[BzaDem]

46. The bill doesn't change employer plans.

It only affects the individual market (those that don't already get comprehensive coverage at work).

For the individual market, the bill caps premiums at a percentage of your income for those up to 400% FPL. It doesn't matter what the premium is, since the government picks up every penny of the premium above that percentage of your income. For someone at 150% fpl, that's 3%. For someone at 400%, that's 9.5%. It also picks up much of deductibles and cost sharing for those below 200% of FPL.

Though all of this is completely irrelevant to your post. You said subsidies somehow weren't guaranteed. That is flat out false -- they are guaranteed to the penny. If you have additional questions about the bill, you should start another topic. The only reason I posted was to correct your misinformation.

[Better Believe It]

47. Exactly! That was one of the points I made!

As I pointed out and you just confirmed: "And the numbers provided at your link are mere estimates and don't even cover insurance coverage provided by employers!"

And under this health insurance industry legislation the government will have absolutely no power to stop insurance companies from increasing their premiums, co-pays and deductibles!

That's some reform!

Can you at least tell me what private insurance options we will have in 2014?

And how much will insurance premiums, co-pays and deductibles cost in the private individual market and what kind of coverage will they provide?

I still can'tseem to get an answer to that all important question.

Just a lot of gobbledeegook in response.

I'm listening.

[mzmolly]

27. Yes, this is a temporary solution to McDonalds saying they'd drop

coverage if they had to comply before the new system goes into effect. But I love the spin of the OP, don't you? The exclamation point at the end of the spin, was extra special!

:hi:

[Lucky 13]

41. They are exempting a multi billion $ corporation from legislation they just passed..

Where's the spin? Isn't that what happened?

A corporation threatens. We cave. Instead of saying, no, this is the law and no, you can't just drop everyone's coverage. I imagine there were at least a few legal avenues that could have been pursued.

Everyone keeps saying, "Wait till 2014!!"

Just like everyone kept saying, "Just wait till we get a democratic Prez!" and then "Just wait until he gets through 6 months in office!" and then "Just wait until he's been in office over a year!" and then "Just wait until we get past the mid-terms!"

It's all a fucking shell game. We're always waiting and help's never coming.

[Lucky 13]

3. Ahh!! I am awash in hope-filled "change"!!

Fuck. this. shit.

[NotThisTime]

6. +1 Corporations rule the Government

[Better Believe It]

10. Here's two other recent exemptions given to the employers/insurance industry under this "reform"

From the same article:

Mini-med plans earlier won a separate exemption that allows them to keep low limits on annual benefits. Most traditional plans are being forced to phase out such limits. More than 100 employers and other health-insurance providers received the exemption, including McDonald's, restaurant chain Ruby Tuesday and retailer Meijer.

Also, the administration this month made it easier for employers to switch carriers while retaining "grandfathered" status, which means they won't be required for the time being to follow certain new coverage mandates in the health law.

[mzmolly]

28. .... again until the new "reform" is systematically implemented in 2014.

eom

[Vinca]

12. Isn't this why we need bona fide health CARE reform?

A McDonald's employee will pay $680 a year for this lousy plan that wouldn't cover an infected toenail. They'll go bankrupt as quickly as a person without this crummy insurance plan if they have even a mildly serious illness. This sure as hell isn't "change we can believe in."

[BzaDem]

13. Of course, you forget to say that this is just until 2014, after which they can get comprehensive

policies on the exchanges.

The point of the law was to ban mini med plans AFTER a substitute became available. Not to ban them beforehand substitute became available.

[Better Believe It]

31. How much will those policies cost and exactly how much money in subsidies will be provided?

Oh .... and while you're at it, what will the co-pays and deductibles be on the different policies the insurance industry will provide?

Specifics and credible links please.

Not mere assertions.

Thank you.

[madrchsod]

16. so it`s around 670 for 2000 worth of medical care?

that amounts to seeing the doctor about 10 times a year...forget about any medical procedures.

[mzmolly]

25. Temporarilly!!!! "The agency predicts that by 2014, mini-med plans will effectively disappear...

From your own article: "The agency predicts that by 2014, mini-med plans will effectively disappear when the new insurance exchanges open for business, and it says the looser rules are meant as a bridge between now and then. Lower earners will qualify for new insurance tax credits.

Starting in 2014, many low wage workers will shift to getting their coverage inside new health insurance exchanges, because that's where they can tap tax credits to offset their costs. Stricter rules for the minimum benefits that employers can offer are expected to displace the plans altogether."

The continued attempt to mislead people here about the President, is quite sad.

[Better Believe It]

32. How much will these insurance policies cost us? And what are the benefits,

co-pays, deductibles?

Specifics please.

Thank you.

[mzmolly]

33. There is more info in the article you posted.

Haven't you read it?

[Better Believe It]

36. That's all well and good but it doesn't answer any of the questions I just asked you!

Once again:

How much will these insurance policies cost us? And what are the benefits, co-pays and deductibles?

Specifics please.

Thank you.

[mzmolly]

37. Yes it does. It says they'll pay what they pay now and they'll received a specific

benefit. Specifics are noted.

[Better Believe It]

44. So insurance rates, co-pays and deductibles won't go up and benefits will be the same! Prove it.

With links please.

[laughingliberal]

29. And people said there wouldn't be changes to our important 'first step.' nt

[mzmolly]

34. Who? Other people said "kill the bill" so I have a hard time when they lament

about it taking a couple of years to fully implement.

[laughingliberal]

38. The lament is that any good that may have been there will be stripped before implementation

and many predicted that when we were being yelled at to support it.

[ileus]

40. Here's 111 waivers

http://www.hhs.gov/ociio/regulations/approved_applications_for_waiver.html

[Autumn]

42. Thank you for that link.

I know a couple of people who work for Convergys. They consistently fuck over the people who work for them.

[johnaries]

43. It's TEMPORARY! Read the rest of the article. nt