I had a delightful conversation with a health Insurance company rep this morning

Yes, dondiego, i was referring to the 80/20 loss provision of the law...thank you for the kind, snark free correction.
Quote

Originally posted by: DonDiego
Quote

Originally posted by: pjstroh
Insurance companies are free to charge whatever rates they want so long as they dont go beyond 20% profit margins for the care they provide. They can pay a doctor $1000 or $1 for a bandaid. Thats their business..and that was true both before Obamacare and now.

20% profit margin ?...
Nope, neither of you is correct, it's not about the profit margin.

The Obamacare Medical Loss Ratio requires that health insurance companies spend between 80-85% of their premiums on actual medical care, NOT on marketing expenses, NOT on overhead, and NOT on executive compensation, among other stuff. The Kaiser Family Foundation says that for the first two years of the Obamacare MLR, consumers saved $3.3 billion.





How much is spent on bringing Harry Reid out from his moronic state of denial? And a few hundred thousand spent on getting Sebelius out of elementary grades before she gets run over by Obama's bus, might help too.
Quote

Originally posted by: forkushV
Nope, neither of you is correct, it's not about the profit margin.

The Obamacare Medical Loss Ratio requires that health insurance companies spend between 80-85% of their premiums on actual medical care, NOT on marketing expenses, NOT on overhead, and NOT on executive compensation, among other stuff. The Kaiser Family Foundation says that for the first two years of the Obamacare MLR, consumers saved $3.3 billion

Well technically, pjstroh just didn't know the meaning of the term profit margin.
And DonDiego is correct; the 80/20 Rule applies to individual policies; and DonDiego was addressing pjstroh's confusion with the 80/20 Rule.
And forkush is partly correct; there is an 85/15 Rule applicable to group insurance for "large groups"', over 50 persons; the 80/20 Rule applies to "small groups", under 50 persons and individual polices.

Just sticking with the 80/20 Rule, the Obamacare Law [aka ACA] says that companies must spend 80% of their revenue on medical care or medically related programs, and if they do not they must rebate the difference to the insurance premium.
80% or issue a rebate on the premium to cover the underspending. That's the Law.
80%. It Is The Law.

Or at least it has been the Law. But we live in the "Age of President's Can Change a Law if They Please and Bypass the 200+year Historical Precedent That Only Congress may Amend a Law".
Things are different nowadays. Why one can see women's exposed ankles on the street if one is observant nowadays.

So on Friday March 14th - news the Administration doesn't want to be too widespread is always released on a Friday - the Department of Health and Human Services [HHS], the first and only agency scheduled to spend over $1-Trillion-per-year, announced a proposed "rule change", . . . "rule change" is what they call changing a Law nowadays.

In anticipation of, . . . umm, . . . ahh, . . . "damages" likely to be inflicted on insurance companies' administrative costs because of the incompetent rollout and subsequent administration of Obamacare on the part of the Government, HHS proposes to make it the 78/22 Rule for 2015. And who knows what the rule will be in 2016?

In fact Representative Diane Black [R-TN], apparently a believer in the old-school "a Law is a Law" rule, has raised an objection to HHS Secretary Kathleen Sebelius:
"In the proposed rules, you have indicated that this adjustment in the ‘medical loss ratio’, or 80/20 rule, is due to the possibility of increased administrative costs in 2015. However, adjusting the percentage that insurance providers are required to spend on medical care by two percent would have the combined impact of reducing the amount that insurance providers will be required to pay for people’s medical care while increasing the amount that insurance companies are allowed to retain for profit and for executive pay."
“This is deeply concerning, as it could result in higher out of pocket costs for consumers solely for the benefit of the insurance industry.”
“If this rule were to take effect for 2015, what reasonable expectation can consumers have that it would be reversed in 2016 or later years?
[boldface added -DD]

Wait a minute! "reducing what insurance companies must pay for medical care and increasing what insurance companies may retain for profit and executives" ? ? ? Heresy ! DonDiego claims heresy against The Obama !

"When I use a word," Humpty Dumpty said, in rather a scornful tone, "it means just what I choose it to mean- neither more nor less."
__Through the Looking Glass

Indeed it begins to look like the other side of the looking glass. DonDiego wonders how many folks applauding the President's propensity to change laws on a whim would retain their positive opinion of the practice if a Republican were to become President someday, . . . maybe soon.



This math is complicated.

Quote

Originally posted by: alanleroyII
Quote

Originally posted by: DonDiego
In anticipation of, . . . umm, . . . ahh, . . . "damages" likely to be inflicted on insurance companies' administrative costs because of the incompetent rollout and subsequent administration of Obamacare on the part of the Government, HHS proposes to make it the 78/28 Rule for 2015. And who knows what the rule will be in 2016?


How Obama can allocate 106% of premiums is truly Godlike.....or maybe you meant 78/22.
Corrected. If alanleroy were to blank-out his post, nobody'd ever know.

Quote

Originally posted by: DonDiego
Quote

Originally posted by: alanleroyII
Quote

Originally posted by: DonDiego
In anticipation of, . . . umm, . . . ahh, . . . "damages" likely to be inflicted on insurance companies' administrative costs because of the incompetent rollout and subsequent administration of Obamacare on the part of the Government, HHS proposes to make it the 78/22 Rule for 2015. And who knows what the rule will be in 2016?


This math is complicated.
alanleroyii is funnier than alanleroy

Yep

Quote

Originally posted by: alanleroyII
Quote

Originally posted by: DonDiego
Quote

Originally posted by: alanleroyII
Quote

Originally posted by: DonDiego
In anticipation of, . . . umm, . . . ahh, . . . "damages" likely to be inflicted on insurance companies' administrative costs because of the incompetent rollout and subsequent administration of Obamacare on the part of the Government, HHS proposes to make it the 78/22 Rule for 2015. And who knows what the rule will be in 2016?


This math is complicated.
alanleroyii is funnier than alanleroy

Yep
That's much better. DonDiego thanks alanleroyII for his cooperation.

Quote

Originally posted by: DonDiego
Quote

Originally posted by: alanleroyII
Quote

Originally posted by: DonDiego
Quote

Originally posted by: alanleroyII
Quote

Originally posted by: DonDiego
In anticipation of, . . . umm, . . . ahh, . . . "damages" likely to be inflicted on insurance companies' administrative costs because of the incompetent rollout and subsequent administration of Obamacare on the part of the Government, HHS proposes to make it the 78/22 Rule for 2015. And who knows what the rule will be in 2016?


This math is complicated.
alanleroyii is funnier than alanleroy

Yep
That's much better. DonDiego thanks alanleroyII for his cooperation.

Nobody will ever know.

Forkie, why doesn't Obamacare require insurance companies to spend 95% on medical care. Hell, why not 100%?


Quote

Originally posted by: forkushV
Quote

Originally posted by: DonDiego
Quote

Originally posted by: pjstroh
Insurance companies are free to charge whatever rates they want so long as they dont go beyond 20% profit margins for the care they provide. They can pay a doctor $1000 or $1 for a bandaid. Thats their business..and that was true both before Obamacare and now.

20% profit margin ?...
Nope, neither of you is correct, it's not about the profit margin.

The Obamacare Medical Loss Ratio requires that health insurance companies spend between 80-85% of their premiums on actual medical care, NOT on marketing expenses, NOT on overhead, and NOT on executive compensation, among other stuff. The Kaiser Family Foundation says that for the first two years of the Obamacare MLR, consumers saved $3.3 billion.





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