Breaking: Manager's amendment unveiled. 85/80 medical loss ratio in the bill.

[BzaDem]

http://tpmdc.talkingpointsmemo.com/2009/12/abortion-compromise-reached-nelson-to-issue-statement-shortly.php#more

"Medical Loss Ratio 85/80 percent - Insurance companies will be forced to spend more money on care and less money padding their bottom line."

I believe this means that health insurance companies must spend at least 85% of all revenues on medical care in the large group market, and 80% in the individual market. I think this is the maximum the CBO allowed if Reid didn't want the CBO to declare that the bill nationalizes all health insurance companies.

[Captain Hilts]

1. Individuals get screwed, again. nt

[yourout]

2. Why do I still think insurance companies will have plenty of loopholes.

[lapfog_1]

3. It as 85 / 90.

and, as I've pointed out on many many other threads, this does NOTHING to reduce costs, and, in fact, creates incentive for the insurance companies to INCREASE costs (their own costs for covered services).

It makes all of health care into a giant "cost plus award fee" contract. As a former federal government contracting officer, let me tell you that "cost+" contracts were ALWAYS the worst deal for taxpayers.

[NNN0LHI]

4. Starting immediately children cannot be denied health coverage due to pre-existing conditions

I like that part.

Don

[Phoebe Loosinhouse]

7. Why just children? Why not everyone? nt

[BzaDem]

9. It will apply to everyone in 2014.

The reason that it can't apply to everyone before that is that you need the mandate to ban the discrimination based on pre-existing conditions (or you would have a premium-raising adverse-selection induced death spiral). The mandate has to wait until 2014 because the subsidies (which would be needed to help the poor if there were any mandate) also have to wait to 2014. The subsidies have to wait until 2014 because that allows the bill to be deficit neutral over 10 years (10 years of taxes but only 6 years of spending = deficit neutrality).

Kind of convoluted, but there you have it.

(Though there is assistance to those with pre-existing conditions before 2014. It comes in the form of a subsidized high-risk pool. That means people with pre-existing conditions will get a huge discount on their current rate until 2014, though not nearly as good as the premium of a healthy person which they will get in 2014.)

[Phoebe Loosinhouse]

11. Well, let's see if the high risk pool makes it into the final bill - I hope so

That would actually help save lives and make the entire bill worth voting for. BUT, that is only is the house bill and there has been NO discussion of it that I can see.

[cali]

5. Since y9ou know everything about this legislation, who is going to enforce

this? How much is allotted to enforcement?

[Sanity Claws]

6. So the 15-20% is to cover insurers' salaries and profits?

This doesn't sound right.

The insurers spend a lot on salaries and bonuses, particularly for their high-level executives. I don't see how their salaries can be considered part of "delivery of medical services" but I also don't see how 15-20% is supposed to cover all salaries, bonuses, and profits.

[Phoebe Loosinhouse]

8. Medicare has a 3% overhead, This is a windfall for the insurers

and just chisels their profit margins in stone. I agree with the poster who calls this a "cost-plus" contract.

By the way, the previous language that they "compromised" was 90-95%. I would say the insurers won big on this one.

[BzaDem]

10. There aren't that many high level executives in a company.

So while the top few executives do get ridiculous bonuses, there are only a few of them (compared to the millions of premium payers).

[Jamastiene]

12. I still don't want to buy their damn yachts with money I don't even have. n/t

[Phoebe Loosinhouse]

13. There doesn't need to be. A single exec at Untied Health once cleared

a billion in pay, bonuses and stock awards. Unconscionable. While they deny care to those in need.

I don't get your point. This legislates and enables corporate bloat at the citizens' expense - who cares if one guy gets the swag or twenty? Completely irrelevant.

[BzaDem]

14. I completely agree that it is disgusting.

The question for me is do we kill health insurance for 31 million Americans (possibly for a decade) over the bonuses of a few executives? My opinion is no.

[backscatter712]

15. It's a tough dilemma.

For all the arguing about whether to pass it or not, I think everyone here agrees that the Senate bill just utterly sucks.