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Posted on 02/25/2016 10:53:21 AM PST by Oldeconomybuyer
Pennsylvania doctors say they will be forced to pay the price for what they deem poor business decisions that caused health insurer Highmark to lose hundreds of millions on customers covered as a result of the Affordable Care Act, or Obamacare.
Highmark recently notified doctors it will cut their payments by 4.5 percent for medical care provided to people covered by Obamacare plans.
Highmark's 2015 loss on Obamacare plans, which still isn't finalized, is expected to reach about $500 million.
Highmark attributes the Obamacare losses to new customers who may not have previously had insurance, and who turned out to be sicker, and in need of more medical care, than Highmark expected when setting premiums.
Many insurers around the country are facing the same problem.
Before the ACA, insurers could look at the medical histories of customers and set appropriately high premiums or reject them. But the ACA bans that practice, known as medical underwriting. Insurers now must accept everyone, regardless of their preexisting conditions, and have less latitude in charging higher premiums to people with serious medical conditions.
(Excerpt) Read more at pennlive.com ...
Anyone still not believe we’re going to end up with Single Payer? Regardless of who wins this election?
quote “Highmark attributes the Obamacare losses to new customers who may not have previously had insurance, and who turned out to be sicker, and in need of more medical care, than Highmark expected when setting premiums.”
ROFL
wow... who would have expected the already sick to rush out and get insurance they couldn’t be turned down for!
*slap head* !
Miller pointed out that the federal government hasn’t fully kept its promise to offset losses of insurers who set premiums too low during the initial years of Obamacare. While insurers have received some of these payments, Congress has cut part of the program.
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Actually, Congress, for the 2nd year in a row, added language to the budget bill that just made sure Obama/HHS had to comply with the letter of the original law .... they did not “cut” anything. Obama was going to take money out of other funds (taxpayer money) when the risk corridor fund (money put in by insurance companies) didn’t have enough to reimburse insurers for losses in the amount they requested .... when this happened, the insurers only got 12.6% of what they asked for. Lots of “squalling” going on & insurers will be exiting the Obamacare market place in droves because the Obamacare business model does not work.
“*slap head* !
Frightening,isn’t it?
I’m glad I never heard of Highmark.
.
That agreed to accept payments based on a scam, and now they are losing money? No sympathy from me. Maybe absorbing their losses will teach them not to participate in corrupt enterprises in the future.
To reduce the risk to the insurance companies, a reserve fund called a risk corridor was established to compensate them for losses on their policies during Obamacare's first three years of operations. It was funded by a tax on any profits realized by other insurance companies on their Obamacare policies.
Only problem very few insurance companies paid into the reserve fund due to lack of profits!
Highmark Blue Cross/Blue shield is in Pennsylvania. They are one of the major insurers where I live. The cut reimbursement to my local hospitals, and when the hospitals then refused to accept their insurance the local media completely vilified not the insurer, but the hospital for denying patients access to their care. There was no mention of the gigantic loss of revenue in the hospitals and resultant layoff of hospital staff. The media reporting was so one sided and disgusting.
Turns out a Highmark big wig was once former county chief executive where I live and was majorly politically connect. Shocker.
Somewhere along the line, this post got adulterated in my buffer.
I am sorry for the mess.
Part of financing 0bamacare was the nationalization of federal student loans. The loans were all to be issued by the Department of Education, with the interest rate stepping up to 6.8% two years after 0bamacare went into effect. The government was going to “borrow” the student loan money from the Fed at 3%, loan it out at 6.8%, and the profit was to go to fund 0bamacare. It was all part of the “fuzzy math” and concocted financial sheets that supposedly made it “affordable.” But in order for 0bamacare to even look remotely fiscally sustainable, they had to have the student loan money.
Well, go forward two years, and the bill to increase interest rates on student loans to 6.8% came up, and the predictable happened. The Bernie Sanders supporting millenials had a cow. How dare the government increase their loan rates? If I recall correctly, the rate increase didn’t happen.
And so the government abandons even the phoney-baloney numbers and fiscal plan. Now the money isn’t there to reimburse the insurers as 0bama said it would.
It’s a total disaster. Just as it was intended to be.
Great idea!
A 1000 patients per doctor ratio is ideal anyway.
Schedule your visits a year ahead of time.
Yup .... to expound on the subject (people who write/explain better than I do):
Good article:
UnitedHealth Group Losing Big Money and Threatening to Leave the Obamacare Exchanges—Because the Obamacare Insurance Business Model Does Not Work
http://healthpolicyandmarket.blogspot.com/2015/11/unitedhealth-group-losing-big-money-and.html
Excerpt: That the Affordable Care Act’s individual market risk pool is so far unacceptable was reinforced by a recent McKinsey report that health insurers lost an aggregate $2.5 billion in the individual health insurance market in 2014—an average of $163 per enrollee. They reported that only 36% of health plans in the individual market made money in 2014—and that was before they found out that the federal government was only going to pay off on 12.6% of the risk corridor reinsurance payments the carriers expected and many had already booked.
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Did Rubio deal a mortal blow to ObamaCare?
http://hotair.com/archives/2015/11/25/did-rubio-deal-a-mortal-blow-to-obamacare/
Excerpt: Two years ago, Marco Rubio won a fight during the budget battles to include a requirement for HHS to maintain budget neutrality in its risk-corridor programs. Rubio had pushed back against this program for months, claiming — as it happens, accurately — that it was a back-door bailout of the insurance companies that had cooperated in the effort to pass ObamaCare. Instead of allowing HHS to dip into general funds for risk-corridor payments, Rubio’s rider restricted those payouts to funds collected from taxes on insurers.
The move forced HHS to cut expected risk corridor payments to pennies on the dollar, and prompted the closure of more than half of the co-ops launched by HHS to provide supposedly low-cost coverage. Now that United Healthcare has signaled that it may cut its losses and get out of the ObamaCaure market, The Hill credits Rubio with starting the death spiral many predicted when Democrats first passed ObamaCare in March 2010
I’m a Pennsylvania resident with Highmark Blue Cross Blue Shield coverage and they just raised my copay for regular doctor visits from $20 to $25. So I assume the specialist copay will be $35.
We need a version of the Monopoly Board Game based on Obamacare.
The object of the game is to get your opponents or the hospitals or the doctors or the government to pay for your health care.
How many of the insurance companies were out protesting before the passing of O’Shitcare? If any, I missed it.
As you know, they all thought Obamacare was a GREAT idea ... they would have a “captive” market with everybody being forced to buy their product or pay that horrible penalty. The sheeple were expected to comply. If they did lose money, the government would cover their losses.
The (healthy) sheeple aren’t complying in the numbers expected and the government is not paying up in the amounts expected. It’s not quite working out to be the sweet deal the insurance companies thought it would be.
Ya think?
But the ACA bans that practice, known as medical underwriting.
Imagine that... the government banned insurance underwriting--the most fundamental practice of insurance. What could go wrong? Oh... yeah... everything.
Doctors? Doctors don’t need the money. They’re rich. They should be forced to work for free.
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