As people have grown more familiar with the aspects of the ACA that have already taken effect, many find they like having insurance work for them, instead of against them. If we get more time, maybe someday even TeaPublicans might admit it is a good thing, albeit flawed. (Yeah, I know... in my dreams) Yesterday the St. Louis Post Dispatch printed an editorial about one of my favorite parts of the ACA and made the point that citizens will lose and insurance companies will win (again) if the Supreme Courtservatives rule against ObamaCare.
Follow me below the squiggle for some links and discussion.
It is a radical concept, but Congress decided that health care insurers have to actually use most of your premiums for patient care and not give them all away to stockholders and CEOs. Amazing, right? From Forbes, back in December:
The Bomb Buried In Obamacare Explodes Today-Hallelujah!.
That would be the provision of the law, called the medical loss ratio, that requires health insurance companies to spend 80% of the consumers’ premium dollars they collect—85% for large group insurers—on actual medical care rather than overhead, marketing expenses and profit. Failure on the part of insurers to meet this requirement will result in the insurers having to send their customers a rebate check representing the amount in which they underspend on actual medical care.
Accountability? Yes! I'm good with that.
In Missouri alone that amounts to 64.5 million dollars going to 655,000 people. The KFF link directly below (warning! PDF) gives estimates for some other states based on plan type and size. Suffice it to say that there has been widespread overcharging.
The Kaiser Family Foundation has thoughts on what this can mean long term:
The rebates provided under the Medical Loss Ratio provision, while not particularly large in many instances, are among the more tangible effects of the ACA felt by consumers until the major provisions of the health reform law go into effect in 2014. They do not, however, show the full impact of the higher MLR thresholds. The presence of these thresholds and the corresponding rebate requirement have provided an incentive for insurers to seek lower premium increases than they would have otherwise, and in some cases premiums have even decreased. This “sentinel” effect on premiums has likely produced more savings for consumers and employers than the rebates themselves.
Personally, I hope the Forbes article is correct and that this is the first step toward universal health care:
Rather, the medical loss ratio will, ultimately, lead to the death of large parts of the private, for-profit health insurance industry.
Why? Because there is absolutely no way for-profit health insurers are going to be able to learn how to get by and still make a profit while being forced to spend at least 80 percent of their receipts providing their customers with the coverage for which they paid. If they could, we likely would never have seen the extraordinary efforts made by these companies to avoid paying benefits to their customers at the very moment they need it the most.
If health insurers aren't happy making reasonable profits, instead of huge profits, then good riddance.
Is it possible our lawmakers were smart enough to have planned this, or is it just a happy coincidence? All I know is that if the ACA is struck down, big business wins and we all fall even further behind.