ANALYSIS: Cynical attempts to undo health care reform

House Republicans, unable to repeal President Obama’s health care reform law outright, have decided to go after it piece by piece. If they are successful, what’s likely to remain is the kind of reform the insurance industry dreamed of but never really thought could be the law of the land.

Although the Republican-controlled House passed legislation to repeal the Affordable Care Act several months ago, the Senate, controlled by Democrats, rejected it. Bills are now being considered in the House that would strip some of the most important consumer protections from the new law. If the bills’ sponsors are successful, health insurers would be free to spend as little of our premium dollars on our health care as they want, and they would be able to continue setting lifetime limits on policies and cancel our coverage at the time we need it most—when we get sick. Other important benefits to consumers would also disappear.

Because of my nearly 20 years of experience as an executive of two large insurance firms, I was asked to provide my perspective on the legislation at a hearing today of the House Energy and Commerce Subcommittee on Health.

One of the bills would eliminate a provision of the reform law that requires insurers to spend at least 80 percent of what we pay in premiums on actual medical care. The insurance industry tried without success to keep that provision out of the final bill, so they are solidly behind the effort to do away with it.

As I am explaining to the lawmakers, there is a single-minded focus among the big for-profit insurers on being able to show Wall Street and investors two things every three months: that the companies made more money during the most recent three months than during the same period a year earlier, and that the portion of each policyholder’s premium devoted to covering medical expenses was less than it was the previous year.

When insurers release their quarterly earnings reports, investors and analysts look for two key figures: earnings per share, which is common to all companies; and the medical loss-ratio (MLR), which is unique to the health insurance industry. The MLR is the ratio between what an insurer actually pays out in claims and what it has left over to cover executive pay, underwriting, lobbying, sales, marketing, public relations, other administrative expenses, and, of course, profits.

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ANALYSIS: Cynical attempts to undo health care reform
ANALYSIS: Cynical attempts to undo health care reform

None that I know of have trimmed the salaries of their CEOs and other top executives to meet the MLR requirements. They could, of course, but average executive compensation at the big insurers has gone up instead of down since the law was passed.



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