Download PDF Report >>> Insurers’ Efforts to Shift Admin Costs
Senator Rockefeller recently came out with a report cautioning about health insurers efforts to shift Selling, General and Administrative (SGA) expenses to medical costs. A shift would increase medical loss ratios (MLR) allowing insurers to keep more earnings. Two uncertainties affect predictions. First is how plans are grouped and second is how one computes “medical costs” and “premiums”. Below are reasonable interpretations of the new law that favor consumers, not insurers.
HOW ENROLLEES ARE GROUPED
The first order is to define “group.” The more groups are combined, the greater the opportunity for balancing out gains and losses, which is the whole idea of insurance. Continue reading
Filed under: Analyses, Health Costs, Health Insurers, Health Quality, Healthcare Reform, MLR - Financial Ratios | Tagged: bad blocks of business, federal mandate, large groups, medical costs, medical loss ratio, MLR, Premiums, profitable business, R&D, Selling General and Adminstrative, Senator Rockefeller, SG&A, Small groups | Leave a comment »
Health Reform Trends, Research and Analysis 
Attacks Can’t Obscure Health Law’s Valuable Benefits
Download PDF version Report>> Attacks cant obscure benefits-Huff Post
Huffington Post Posted: September 23, 2010 09:04 AM
http://www.huffingtonpost.com/andrew-kurz/attacks-cant-obscure-heal_b_735873.html
Attacks Can’t Obscure Health Law’s Valuable Benefits
After decades of trying, health care reform is finally a reality. The Affordable Care Act (ACA) is sweeping in scope (it has more than 300 sections) and takes four years to implement. Critics say Americans don’t want it, but if that’s true, it’s only because of false claims by those who do not know what its provisions are or who are being spun by people who have an economic or political interest in blocking the law.
Health reform provides coverage to millions of people while correcting many current and serious defects. It isn’t perfect, but it has countless positive elements being ignored by critics. One key example is Section 2718, “Bringing down the cost of health care coverage,” which takes effect today (September 23). It brings sorely needed cost-control mechanisms while retaining health insurers’ ability to innovate. The provisions of section 2718 are eminently reasonable, and if the atmosphere were not so politically charged, they would receive strong bipartisan support.
Insurance accounting used to be straightforward. The hospital sent a bill. The insurer paid most of it, and forwarded the balance to you or your employer. With the advent of for-profit insurers, which now dominate the industry, accounting and classification of costs have become creative enterprises. Continue reading →
Filed under: Commentary, Congress, Healthcare Reform | Tagged: ACA, accounting standards, Affordable Care Act, better cost comparisons, competition, cost control, credit card, definitions, excess profits, health promotion, Huffington Post, medical errors, medical loss ratio, MLR, NAIC, National Association of Insurance Commissioners, ObamaCare, patient safety, section 2718, transparency, wasteful admin | Leave a comment »