Posted on 02/16/2013 7:20:45 PM PST by Libloather
A proposed federal rule to cap profit margins for certain health insurance plans and prescription drug benefit programs is now available for review.
The latest in a raft of rules required by President Obama’s landmark healthcare law, the proposed rule was drafted by the Centers for Medicare and Medicaid Services (CMS) and sent to Pennsylvania Avenue on Thursday.
The White House’s Office of Information and Regulatory Affairs (OIRA) is moving quickly to issue the proposal, which will hit the Federal Register on Tuesday. That begins a 60-day comment period. CMS will consider all comments before finalizing the rule.
The 116-page proposed rule can be read here. The rule is considered economically significant, meaning it carries an economic impact of more than $100 million.
The measure would implement 85-percent “medical loss ratio” requirements on Medicare Advantage plans and the Medicare Prescription Drug Benefit Program. In other words, plans that deliver services under those plans must spend at least 85 percent of their premiums on “clinical services, prescription drugs, quality improving activities, and direct benefits to beneficiaries,” according to the proposal.
Overhead expenses and profits would be capped at 15 percent.
While those broad contours of the plan were set out in the Affordable Care Act, the healthcare industry has anxiously awaited the proposed language, which details nuances of the forthcoming regulations.
The rule would also institute penalties for those providers that fail to meet the caps requirements.
“If a plan sponsor fails to meet MLR requirements for more than 3 consecutive years, they will also be subject to enrollment sanctions and, after 5 consecutive years, to contract termination,” according to language in the proposal.
Since 2011, most general health insurers have been required to spend either 80 percent or 85 percent of their revenue on medical expenses, depending on their size. The rule expanding caps to Medicare Advantage - a program aimed at the elderly and disabled - and the Prescription Drug Benefit Program is set to take effect next January.
Instead of Atlas Shrugged, it'll be your Doctor SHRUGGED and SHUNNED you!!!
That is it, exactly.
...you get LESS of it.
Prepare yourself, and your families, for SHORTAGES of anything that is so regulated.
God help us all.
Rent controls, price controls, etc., have never worked. Plenty of historical examples, foreign and domestic, prove that.
And the liberals never look at history nor economics. They simply refuse to learn.
They do love their social experimentation, don't they?
And when they fail--and their program will--they will find a scapegoat, usually some party with money or an interest.
Blame Big Pharma. Yeah, that will be the ticket.
Yep. Just as he learned from his absentee alcoholic commie daddy and Dirty Old Man Frank Marshall Davis.
What it amounts to is, the gubmint will decide whether health care is a good business to be in. And, since the gubmint wants to be in the business itself, it naturally doesn't want other players screwing up the marketplace with unnecessary, wasteful and ill-advised choices for consumers. So, of course, there's no need for health care to be a profitable occupation ... let's just assign the docs a schedule of GS levels and leave it at that! We don't need no stinkin' Ben Carsons!
Which is fine and dandy, as long as you are healthy and not a US tax payer.
Fixed it.
This administration is destroying the medical business. The medical tax on 0bamacare is another example.
He will find companies and people who will “pay to play” pay the vig meanwhile everyone else will be moving to a more capitalistic climate. What do you call a government cap on profits in the private sector?
Yes, I’m reading it now. It’s freaky how parallel the book is to Zero’s governing style and our society. There’s even a “You didn’t build that” type quote in it. It is literally shocking how closely it parallels.
The goal is 80%. They will end up with 75%
One more thought.......
If the President kills Medicare Advantage, he is not going to survive the end of his term
And let’s do the same to the faceless bureaucrats who administer this crap.
Now THATS hope and change I could believe in!
Another anti-Constitutional, un-American dictate from the mad Kenyan.
Setting an allowable profit margin on private industry? Communism at its core, and just what one would expect from Zero and 0bamunists.
A pox on all their houses.
Oh, and don't get sick again. That's an order.
5.56mm
Excellent point. Thanks for the added perspective.
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