Posted on 09/27/2025 8:42:26 AM PDT by SeekAndFind
Health insurance companies report profits of billions annually while raising premiums on beneficiaries and routinely rejecting patient and medical provider claims. By ignoring the public perception, these companies are inviting increased scrutiny by Congress.
Becker’s Payer Issues reported on February 12, 2025, that the big seven health care companies made a combined $34.1 billion in 2024. These companies include UnitedHealth Group, which led the way with $14.4 billion in profits. These companies were the beneficiaries of additional government support for premiums because of the Obama Administration and COVID pandemic policies which kept premiums artificially low.
These policies are expiring, yet the companies continue to worry more about profits than addressing the high cost of health care because of lower government support to cover the premium cost for consumers.
Even with record profits, health insurance companies are continuing to raise premiums. The KFF reported in 2024 that “over the last year, the average single premium increased by 6% and the average family premium increased by 7%. Comparatively, there was an increase of 4.5% in workers’ wages and inflation of 3.2%.
Over the last five years, the average premium for family coverage has increased by 24%, compared to a 28% increase in workers’ wages and inflation of 23%.” In March of 2023, the COVID era Medicaid spending allowed most Americans to be insured ended with 24 million losing coverage between April 2023 and June 2024.
The bad news is that the rise in health insurance premiums is expected to accelerate in 2026 when premiums are expected to double. The projected expiration of Obamacare premium tax credits next year will lead to an “increase by over 75% on average with premiums at least doubling in 12 states.” Consumers and small businesses who used health care exchanges will experience sticker shock next year…
(Excerpt) Read more at americanthinker.com ...
The Congressional Budget Office (CBO) projects that about four million people will lose coverage in 2026 because of high premiums. Premiums are going through the roof in the upcoming year and which only increases the pain on an already inflated rate.
See here:
https://www.cbo.gov/system/files/2024-07/60523-2024-07-premium-tax-credit.pdf
They scoop up money from customers.
Providing access to healthcare is an afterthought.
Just as orchestrated by the elitists with the 3/5 supermajority that banned opposition speech to win their way to passing this law.
Total end game? Government run all.
thank the “affordable” care act...
See here:
Fierce Healthcare reported, “an increase in overall initial denial rates from 10.15% in 2020 to 11.2% in 2022, and then up again to 11.99% in the first three quarters of 2023.” They looked at 2020-23 “increases in 90-day-plus accounts receivable’s percentage of payer claim value, both for patients with Medicare Advantage (19% to 36%) and commercial (27% to 36%) coverage.”
Other reports indicate that 19% of in-network services are denied while out-of-network denials have hit 37%. A problem is that less than one in a hundred denied claims make it to an appeals process because it is difficult to appeal, yet appeals are usually successful. Estimates range to about $262 billion in denied claims every year.
And the way to fix it is quite simple, Every Public Employee across America, including every member of CONgress and the Judiciary and their staff immediately enroll in the Affordable Care Act at their own expense for their Primary Health Care.
“In 2023 and 2024, 80 percent of marketplace enrollees could find a plan for $10 or less per month on HealthCare.gov, the federal marketplace that operates in 31 states (19 states and the District of Columbia run their own marketplaces).”
“The enhanced subsidies have translated into higher enrollment in ACA marketplace plans and fewer uninsured people. They helped increase enrollment in the marketplaces from 12 million in 2021 to a record 24.2 million in 2025.”
“Medicare Premium Bill....Current Premium Due...Total Amount Due $555.00”
That’s from a document that was and now is on my dining room table.
That was $185/month - for nothing at all in my case.
If you want “Medicare for All” it would be $185/month per person.
It would be reasonable to prorate the premium by age, so a kid about a tenth my age would have a ~$19/month premium at a minimum.
What is relevant is how the long-term profit margin of health insurers stacks up against that of U.S. businesses generally.
Amazing that no one’s mentioned the 12 million ghost accounts on Obamacare that the government pays for, or the 8 million that are double insured in multiple states on Medicare/Medicaid.
This! ↑ ↑ ↑ ↑ ↑ ↑ ↑ ↑ ↑ ↑ ↑ ↑ ↑ ↑ ↑
All going to Obama’s plan
and republicans never killed his plan
They are all worthless
An essential community provider (ECP) is a provider that serves predominantly low-income, medically underserved individuals.*
All medical QHP and SADP issuers must submit information as part of their QHP Application to demonstrate they have a sufficient number and geographic distribution of ECPs, where available, in accordance with 45 CFR 156.235.
CMS has established two ECP standards: the General ECP Standard and the Alternate ECP Standard.
To satisfy the General ECP Standard, the applicant has satisfied the following requirements:
Use a provider network that complies with 45 CFR 156.235, subject to a limited exception for certain SADPs as described in the 2024 Letter to Issuers;
Contract with at least 35 percent of available ECPs in each plan’s service area to participate in the plan’s provider network,** including contract with 35 percent of available Family Planning Providers (not applicable to SADP applicants) and 35 percent of available Federally Qualified Health Centers (FQHCs) in the plan’s service area;
Offer contracts in good faith to at least one ECP in each ECP category in each county in the service area to participate in the plan’s provider network for the respective QHP certification plan year, where an ECP in that category is available (not applicable to SADP applicants);** and
Offer contracts in good faith to all available Indian health care providers in the plan’s service area to participate in the plan’s provider network for the respective QHP certification plan year.
https://www.qhpcertification.cms.gov/QHP/applicationmaterials/Essential-Community-Providers
A brother of mine has an Aetna Medicare Advantage plan, which is a PPO network.
There are a number radiology diagnostic outfits within 10-15 mile radius of where he lives. But when the one he had been going to had there equipment shut down (why???) his appointment with them was cancelled. The found him another appointment, weeks away and fifty miles from where he lives.
If he paid for a Medicare Supplmental G plan (which is on top of Medicare and is not cheap). His doctors could get him a referral to any radiology diagnostic outfit in his area, so sweat, because such plans are not a PPO network and are accepted everywhere Medicare is accepted.
More destruction caused by Obama.
The problem stems from the way health and auto insurance is typically sold - with fixed dollar premiums.
It incentivizes the insurance company to fight for every dollar, which can head directly to its bottom line.
Insureds as a group should if practical bear all of the financial risk, so insurance companies don’t profit from jerking insureds and providers around.
Insurance should have an issue fee [~$100], a potentially refundable issue margin reserve charge [~$100], a monthly profit allocation [~$20], and an offer premium.
As the months go by, a $520/month health insurance offer premium would typically be adjusted by a higher-than-expected payout charge, or a lower-than-expected payout credit.
For January, you might pay $740.
For February, you might pay $540.
For March, you might pay $540.
For April, you might pay $532.
For May, you might pay $545.
....
For December, you might pay $557.
For healthcare insurance, when healthcare claims have almost all been settled, in say May of the following year, you might get a refund of the remaining issue margin reserve charge in the amount of perhaps $56.
For auto insurance, the refund of the remaining issue margin reserve charge might take years to arrive.
People who promote “Medicare for all” talk like the program is free, ignoring not only the monthly premium you mentioned but also the years of payroll deductions.
Thank goodness Obamacare fixed all these problems...
Oh wait.
Even if you are wealthy enough to afford the ridiculous premiums good luck finding a doctor. I figured I would try to go to a doctor for a foot issue. I haven’t been to a doctor for 15 years. In my area the closest doctor accepting new patients was three hours away. And even that was after 6 months. Locals are not accepting any new patients and even paying cash for a podiatrist was 7 months out.
My girlfriend, who actually uses that garbage but she has a GP, had to get surgery. Every procedure is spread out so the yearly out of pocket resets every new year.
Thanks Obama. At least the illegal aliens get the best medical care for free when they want it.
The lesson, if it is not an emergency, save the money and have medical services done overseas.
The language has been captured to communicate falsehoods. Orwell would be proud.
Health Insurance is Sick-Care/Medical insurance, not HEALTH care. Health Insurance does not pay to keep a person healthy, it pays to keep a person sick and pay for the care of that sickness.
Medicaid/Medicare is an extreme example of this.
Can we improve the situation while the language is misused?
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