Archive for Saturday, August 11, 2012

Care act praised

August 11, 2012


To the editor:

When was the last time your health insurance company sent you a letter that was anything other than a denial of coverage or a notice of premium increase? Thought so.

Over the past six years, my health insurance cost increased from $350 per month to $850 per month.  The last time I had a major medical expense, it was denied as not covered. It was, but it took me over eight months to get my reimbursement.

Last week I had a surreal moment. I got a letter from the insurance company. I started grumbling as I opened it, expecting yet another rate increase. I was astounded to find it contained a rebate for a portion of my premiums paid the previous year!

How did this amazing turn of events occur? The Affordable Health Care for America Act, derided by the right as “Obamacare,” includes a provision, called the 80-20 rule, which requires that health insurers spend at least 80 percent of their customers’ premiums on health services, leaving no more than 20 percent for administrative costs and advertising. What a concept!

The AHCAA also requires insurers to end the practices of canceling policies when the insured becomes ill or denying coverage for pre-existing conditions. In exchange, everyone must have insurance. That protects the rest of us from those that would just rely on us to pay their bills through our taxes. Why on earth would anyone think these are bad ideas? Repeal this law? Are you nuts?


bad_dog 1 year, 8 months ago


Please provide a reference for your comment regarding "industry standard" for profits. I've been employed by both Fortune 500 and regional insurers as well as two different state regulators and I've never heard of this profit "standard". When regulators approve product pricing, administrative costs are "presumed" (by the regulators) to be "X%" per premium dollar. Nevertheless, when issued some types of policies are more expensive to administer due to commission splits, marketing costs, claim adjustment expenses, investment requirements tied to a certain book of business, etc. These "presumptions" coupled with industry experience and actuarial projections form the basis for product pricing. Keep in mind these are only educated guesses. I've seen numerous books of business that had loss ratios in excess of 100%. Those ratios are entirely attributable to poor claim experience sans admin costs.

As for your final paragraph, regardless how much an insurer charges, under the ACA they will have to return a portion of those premiums to policy holders if the profits are excessive. What incentive will an insurer have to raise prices if they still have to return excess profits? What will increasing prices do to their market share? Marketplace reputation is a huge issue for insurers, so competitve pricing is essential to their real and perceived success.

As for mocking the writer of this LTE, when was the last time your insurer sent you a check for something other than payment for a loss?


notajayhawk 1 year, 8 months ago

Mr. Burger:

You DO realize that the 80% (and 15% for larger insurers) threshhold was set because that was already the industry standard, didn't you? What? No?

You DO realize that the reason your premiums more than doubled before you got this 'rebate' is the oldest bait-and-switch in the book, raising prices and then lowering them - a tiny fraction of the earlier raise - so the gullible will think they somehow came out ahead? What? You didn't figure that out either?

And most importantly, you DO realize that the only way insurance companies can increase profits now is to RAISE the cost of health CARE for everyone? Just as it has already happened in states that tried setting a mandated loss ratio in the absence of a premium cap? Gee, you didn't know THAT either?

No wonder you're a liberal.


pace 1 year, 8 months ago

The GOP radicals have done war dances on the health care act, more billions on ads and on lies. The health care act will help working families to have health care. Now Romney loads on Ryan ,who is trying to privatize medicare. He doesn't want health care to be available, they want it to be a money machine and a way to control the working people of this country. Yes we pay more for less than most first world countries. The health care bill starts to address that. Lose your job, yes you lost your health care or have to cough up 800 -900 dollars. Available health care will be a boon for the independent person or small business. When you must stay with a company because your family couldn't get health care under the old system. They knew it. Americans should have the right of choice of health care, not just a choice of which large business they must work for. Health care has become not a carrot but a whip for some corporations. By the way, if Romney is going to run on his business record, which include his business ethics, let us see at least the usual paper work. Who ever says the income tax returns aren't really important are fools. He should release at least 10 years. Why should we trust him if he doesn't trust us with the minimum of truth.


jhawkinsf 1 year, 8 months ago

Once we start paying for all this stuff, be it ACA, Medicare, wars around the world, etc., rather than passing the bills on to our children and their children, then we'll really decide which of these things do we want and which can be put off until another time. But as long as we run up debt on someone else's credit card, we'll never have to decide.

Anyone out there want to post their credit card number here and I'll promise no to misuse it.


Enlightenment 1 year, 8 months ago

FYI, the ACA is a working document that has provisions in place that allows changes to be made so that it can quickly change elements that are not working and expedite elements of the act that need tweaking.


Enlightenment 1 year, 8 months ago

It's extremely frightening to think about realty and insurance coverage. In the current system, we rely on employer provided insurance or no coverage at all, except for the very small minority that outright purchase their own insurance, or those that require medicare/medicaid. And now Romney's running mate, Paul Ryan, medicare is at risk if he has any influence. So first off, we need to have a job that offers insurance or we go with out and risk financial bankruptcy if we require medical attention. Second, even if we are fortunate to switch jobs and continue to be provided with employer based insurance, we have no guarantee that the new employer's insurance will cover "pre-existing" conditions and the prescriptions necessary to treat these pre-existing conditions. Again, we risk financial bankruptcy even with insurance coverage simply because of a pre-existing condition that the insurance company decides not to cover. Lastly, even without the ACA, health care expenses are increasing significantly each year and offering less coverage. So even in the off-chance that the ACA results in a slight increase in premiums, we would have paid that regardless. The kicker is that with the ACA, we now have guaranteed coverage, the 80/20 rule, and in fact overall better coverage that includes no deductible services and preventative care.


FalseHopeNoChange 1 year, 8 months ago

Ambiguity in Health Law Could Make Family Coverage Too Costly for Many By ROBERT PEAR Published: August 11, 2012

WASHINGTON — The new health care law is known as the Affordable Care Act. But Democrats in Congress and advocates for low-income people say coverage may be unaffordable for millions of Americans because of a cramped reading of the law by the administration and by the Internal Revenue Service in particular.

Under rules proposed by the service, some working-class families would be unable to afford family coverage offered by their employers, and yet they would not qualify for subsidies provided by the law.


Kirk Larson 1 year, 8 months ago

As to denial of coverage, I have had my insurance tell me something was not covered when I knew it was and had to insist until finally they admitted it was. My niece has a friend who works customer service for an insurance company who told her about the "three strike" rule: it is typical to deny that something is covered three times in the hope that the customer will give up and pay for the service themselves.


Dan Eyler 1 year, 8 months ago

I like choices as a consumer. I am always better off than the government picking for me. Average denial of claims is 4-6% for all health insurance companies. What do you bet with a single payer system that goes up a whole lot more.


Enlightenment 1 year, 8 months ago

The ACA is a great start, but is a working document that will need to be revised over time.

However, Romney is bowing to the GOP and distancing himself from the health care reform in Massachusetts. And to add insult to injury, Romney has Paul Ryan from WI as his VP running mate. A career politician that wants to cut medicare with no alternative. Tell me, how many seniors will be able to afford health care under Ryan's plan?


Leslie Swearingen 1 year, 8 months ago

Great letter and thank you for writing it. I thank God for the medical care I receive and the kindness of those who dispense it. Here is a shout out to all those who worked on this bill in the House and the Senate and a special shout out to then Speaker of the House Nancy Pelosi for the tireless work she did for the cause.


Thomas Bryce 1 year, 8 months ago

The conservatives want to re-write everything to suit them and them alone. Why not start with The Pledge of Allegiance. "I pledge allegiance to the PAC of Grover Norquist and Corporate America. And to the Republicans for which it stands, One nation, under OUR God, Indisputable, with Liberty and Justice for those of you who can afford it."


tomatogrower 1 year, 8 months ago

The ACA is a working document and a start. If something comes up that doesn't work it should be addressed. But of course now we are run by a congress full of the "no' party, so it probably wouldn't happen.

I haven't seen any solution by the Republicans, except Romney as governor of Massachusetts, that seems fair or feasible. Most seem to want to protect the profits of people who invest in insurance companies and the big bonuses collected by insurance company CEOs, not in providing affordable health care to the citizens of the US. The message I have gotten from most of them is "don't get sick, unless you are wealthy enough". Our system is broke, but because some people are making big profits from it, then it's ok, right conservatives?


Armstrong 1 year, 8 months ago

I believe there is a great deal of bivine fecal matter in this letter


jafs 1 year, 8 months ago

This is a silly letter.

Does the author really think these are the only two provisions in the ACA?

Also, if he's paying $850/month for coverage, I think he could do a lot better, unless there are factors we don't know about in his situation.


Abdu Omar 1 year, 8 months ago

Great letter, Doug. I wish many others would see that this bill is a good one, started out of necessity and is more than the Republicans cared to read or bring about an alternative. Thank you President Obama.


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