NEED HELP with HR 3962!

[apnu]

My Employer's health insurance company is threating to raise our company's rates by 40%! What I want to know is are there any provisions in the House Bill that will keep insurance companies from doing this? If so, what sections? I'd like to read the language, and so does my employer (a Republican who's shocked at this sudden price hike for no damn reason by our provider)

[MNDemNY]

1. Nope, you are screwn.

He can just nix your coverage and pay a "fee" of 8 1/2 percent of payroll, and leave you all on your own.

[apnu]

3. What I'm trying to find are provisions in the bill that prevent health insurance from gouging

My employer is a small business and wants to provide health insurance to his employees. He (and myself too) want to know what protections are in the bill that keep the health insurance company from doing exactly what they are doing now to the whole company: jacking our rates 40%

[MNDemNY]

12. There is nothing to help you if this increase is happening now, or in the next year. Nothing.

[rucky]

2. 1> Here's the part of the bill:

SEC. 2714. ENSURING VALUE AND LOWER PREMIUMS.

`(a) In General- Each health insurance issuer that offers health insurance coverage in the small or large group market shall provide that for any plan year in which the coverage has a medical loss ratio below a level specified by the Secretary (but not less than 85 percent), the issuer shall provide in a manner specified by the Secretary for rebates to enrollees of the amount by which the issuer's medical loss ratio is less than the level so specified.
`(b) Implementation- The Secretary shall establish a uniform definition of medical loss ratio and methodology for determining how to calculate it based on the average medical loss ratio in a health insurance issuer's book of business for the small and large group market. Such methodology shall be designed to take into account the special circumstances of smaller plans, different types of plans, and newer plans. In determining the medical loss ratio, the Secretary shall exclude State taxes and licensing or regulatory fees. Such methodology shall be designed and exceptions shall be established to ensure adequate participation by health insurance issuers, competition in the health insurance market, and value for consumers so that their premiums are used for services.
`(c) Sunset- Subsections (a) and (b) shall not apply to health insurance coverage on and after the first date that health insurance coverage is offered through the Health Insurance Exchange.'.

http://thomas.loc.gov/cgi-bin/query/F?c111:1:./temp/~c111cnjYS9:e40954:

2> Here's what Medical Loss Ratio means:

MLR Medical Loss Ratio (Collection: Managed Care)

The amount of revenues from health insurance premiums that is spent to pay for the medical services covered by the plan. Usually referred to by a ratio, such as 0.96--which means that 96% of premiums were spent on purchasing medical services. The goal is to keep this ratio below 1.00--preferably in the 0.80 range, since the MCO's or insurance company's profit comes from premiums. Currently, successful HMOs do have MLRs in the 0.70-0.80 range.

http://www.mentalhelp.net/poc/view_index.php?idx=37&id=68

3> Much debate about the current industry MLR for group plans:

While the health insurance industry says its average medical loss ratio is 87 percent, a new analysis released by the Senate suggests otherwise.
Back in August, Rockefeller wrote to insurance companies, asking them to reveal their medical loss ratios "broken down by state and by the individual, small, and large group market segments." The goal was to be able to provide valuable information to individuals and companies who are shopping around for health insurance policies. Sen. Rockefeller writes that, "Just as a car buyer might use gas mileage to choose one car model over another, medical loss ratios are a tool that can help consumers compare various health insurance options."
The insurance giants argued that medical loss information is "proprietary" and "business sensitive." So Rockefeller asked the Senate Commerce Committee to investigate. The committee concluded, by examining premium and claims data reported to the National Association of Insurance Commissioners, that the medical loss ratio is significantly lower than the industry would have them believe.
Reed Abelson of the New York Times reports that in 2008, the for-profit average medical loss ratio was 84 percent in policies offered to large employers and 80 percent in policies offered to small businesses. In the individual market, there was an average medical loss ratio of 74 percent. Rockefeller specifically accuses CIGNA of breaking the law and inaccurately reporting information to the NAIC -- they had claimed a medical loss ratio of 93 percent.
The Senate analysis shows that the health insurance industry "provided one set of premium-benefit numbers to the public and to Congress, and presented a different one to their investors." The letter says that America's Health Insurance Plans' (AHIP) claim that the industry spends 87 cents of every premium dollar on medical care was part of an "expensive public relations effort." The publicly-traded health insurers' own financial reporting to the Securities and Exchange Commission does not come close to supporting the figure -- see page 7 of the letter to CIGNA for the individual breakdown.

http://www.newamerica.net/blog/new-health-dialogue/2009/health-reform-medical-loss-ratio-or-just-medical-loss-15773


BOTTOM LINE: I think they made it pretty hard for the insurance industry to game their MLR's in this bill. They even require the Secretary to set the standard for how it's computed. The insurance companies are sure to find a hundred other ways to game this, but it looks like if costs are kept under control, premiums stay low in accordance.

Now to find the wording in the bill on cost controls....

[mullard12ax7]

4. So a government toady will calculate med expenses like the Consumer Price Index

Great, a gov't incentive to lie about the numbers to make themselves look like they're saving money.

[rucky]

6. yeah, it all depends on who's doing the oversight.

if you don't trust the gumbit, you won't like them controlling this.

But it's a heckova lot better than letting the insurers make their own algorithms. Right now, they're proprietary.

[apnu]

7. OK, so this Secretary will be setting rate rules to prevent price gouging...

Am I reading that right? This legal language gives me a head-ache.

[rucky]

8. That's how I'm reading it.

I hate this stuff, too. But it didn't take me long to find it in that 4-foot stack of paper on my podium :)

[apnu]

10. Thanks Rucky, you're a big help.

:toast:

[sandnsea]

5. If he passes that increase on to the employees

and the employees all end up over the 12% mark, then they can all join the exchange.

That and Rucky's response about the 85% cap would resolve issues in the future.

But there's no law against this right now. They can do any damn thing they want to do. That's the entire point. Everybody is surprised when it happens to them. Do you have someone with cancer or other high health care costs in your insurance pool? That is often why this happens.

[apnu]

9. No we do not have anybody in our pool that's suddenly gotten sick

We're a company of > 50 employees, I know each person here personally. Nobody's suddenly gotten sick. Our insurance rep called the president today and told him to expect a 38% price hike for our plan... and to have a nice day.

Both he and I are of the mind that our insurance provider is fucking us, they are scared shitless of the H.R.3962 and decided to jack the company's plan because of that fear.

[sinkingfeeling]

11. Here's a link to a pdf of the bill.

http://docs.house.gov/rules/health/111_ahcaa.pdf