Industry Worries As Regulators Decide on Critical Loss Ratio

By | October 21, 2010

  • October 21, 2010 at 7:31 am
    tiger says:
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    A rather half hearted protest on the part of NAIC with this comment: “,,,
    has said the reforms may make matters worse, at least temporarily.” What they meant to say, I’m sure but couldn’t, is that it will make matters worse permanently…as in forever.

  • October 21, 2010 at 11:29 am
    Cancelled in California says:
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    NAIC should be worried about providers cancelling small groups. It’s already happening out here.

  • October 21, 2010 at 1:01 am
    Sarah says:
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    Hmmmm…. I think I would get out of selling this line of business if I were you!

  • October 21, 2010 at 1:49 am
    System stinks says:
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    I had a visit to the Emergency Room a few months ago. The bill: $19,000. Among the (over)charges: Approximately $300 for a pair of crutches, $1200 for a plastic leg brace consisting of material that literally cannot be worth $20, over $75 for a stinking Ace bandage, $60 for a lousy plastic syringe used for a tetnis (SP?) shot, around $65 for ONE pain killer. You would not believe what the X-Rays cost. The bill was a ridiculous summary of charges for materials worth a fraction of what they really cost. I won’t even go into the cost for a CAT Scan and the charge for the physician who spoke to me for about 10 – 15 minutes. Why the overcharges? Because they can pass it on to the insurance company. It’s good thing I have insurance. The deal with the insurance co enabled them to reduce the bill somewhat. If I had no insurance, the whole thing would have been billed to me. If I was poor, YOU would have picked it up. The system is flawed and is not getting any better until we figure out a way to apply a fair cost to items and services and allow a fair return to the provider. Give credit to those willing to take on the issue of health care reform; unlike the Republicans who have been dragged kicking and screaming into this process. All they did was influence their crackpot idealogy on the process even though they produced Medicair Part D (The Mother of all crackpot ideas). The end product of what was passed last year was the result of the political process and was by no means THE solution. It’s time to hold providers accountable for costs and mandate Tort Reform. Dems don’t like Tort Reform but this should not be a Dem vs. Republican issue. It belongs to everyone.

  • October 21, 2010 at 1:59 am
    Wayne says:
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    Since the republicans were not allowed at the table to provide input on the bill, they had no choice but to be skeptical.

    The democrats had a sufficient majority to pass the bill without republican support so what we have is a one-sided piece of legislation that will result in higher costs, less coverage and less availability of coverage.

  • October 21, 2010 at 2:26 am
    Really says:
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    Republicans not allowed at the table? Really? There was a public healthcare “summit” where I saw alot of the Rebublicans. Hey, they were in power for 8 years and did nothing to improve health care access for the general population. Their big idea was Medicare Part D which was UNFUNDED and was a obvious half-@ssed attempt to curry the elderly vote. How many old folks can work through the $2000 retention in M-Part D? Their big idea was to “scrap the whole plan and start over” That is another phrase for let’s table this thing and hope it goes away. Mitch McConnell and John Boener don’t give a rats @$$ about you or me.

  • October 21, 2010 at 2:35 am
    Elyot Spitser says:
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    The Democrats locked the doors and put the health plan together and then pushed it through without the presence or input of the Republicans. This is documented Fact.
    Healthcare has always been accessible for the general public. They just haven’t spent the money for it in the past. If you watched some of the hearrings, you would have seen hospital after hospital testifying about uninsured people and illegal immigrants coming into the ER and receiving medical attention, and not paying for medical help they got. There was 2 cases of documented illegal immigrants who received care costing over $1million and were still in the care of the hospital, and the hospital tried to send them back to Mexico and Mexico refused to take them.

  • October 21, 2010 at 2:37 am
    Cassandra says:
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    Thanks for telling it like it was/is, Really. McConnell and Boehner are playing their usual political games…and I agree, they don’t give a rats patoot…as long as they get their party re elected. But why is anyone surprised at legislators that do not legislate? That seems to be the state of the Congress these days.

    Not only do the hospitals, as in the example given, overcharge for all the people they say can’t pay, but it would appear we get double charged as the taxpayer…and as the premium paying public. Worst of all worlds.

  • October 21, 2010 at 2:37 am
    GC says:
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    Once again you display your outrageous ignorance and bias for your beloved Obama. He and this Congress and Senate have failed, their policies have failed – and they (the Dems) have been a complete and utter failure for this country. They care ONLY for their power – they don’t care about people or the God-given dignity for people to earn their own money in their own jobs. The fact that they took on this enormous issue in the midst of a depression like economy is the height of arrogance. There were plenty of Republican alternatives on the table including allowing the free market to work! But the Democrats want to control YOU, so they want to control YOUR healthcare. You can bet if this atrocious legislation is allowed to stand, every single Health Care insurer will go out of business. You are so desperately naive if you believe that your beloved President has any other goal that a complete remaking of society by redistributing wealth to the people he deems worthy. Get your head out of the sand and start looking at REALITY instead of in some fantasy land!

  • October 21, 2010 at 2:50 am
    Cassandra says:
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    Stop the diatrribe. you are NOT on point here. I am tired of every issue becoming a forum for your paranoid right wing wind bag libelous repetitive cant.

    Private industry cannot guarantee that those with chronic illnesses and severe pre existing conditions secure insurance. Yet those people have the RIGHT (yes, RIGHT) to be able to protect themselves and their families from financial disaster caused by illness. Your geniuses came up with nothing to answer this except tort reform…another reptitive bleat from the sheep on the right. Yeah, we need it in some states and nationally, but that is not the answer or even 2% of the answer, so dry up already and get onto the larger issues at hand.

    And, incidentally, you are so outraged at the “redistribution of wealth” you don’t even think about what has happened to the middle class in the last two decades. Did your 401K take a dive? Did your housing value drop? Did your wages stay flat or decrease? did the cost of education go up? So now, tell me how wealth is being stolen from the middle classes and why some “rebalancing” is not in order. And tell me who is at fault…or are you going to continue to blame the unions and the liberals? Betcha the bankers on Wall Street don’t vote Dem, GC.

    YOU’RE the ones declaring that this is big class warfare. What a wonderful little propagandist Rove and his minions are. Betcha he could have given Goebbels a run for his money.

  • October 21, 2010 at 2:57 am
    Elyot Spitser says:
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    The IJ had a recent article stating that there are approximately 250,000 people in the US with chronic illness that cannot secure proper medical care. We shouldn’t be passing healthcare reform because .1% of the population has a problem. We should properly address that .1% to make sure they are taken care of. It is the other 29,750,000 that are the problem. Illegal immigrants and people not taking responsibility for themselves, just sitting back and waiting for the government and the taxpayers to take care of them. That is why spread the wealth is a dangerous plan. It continues to incent the lazy to remain lazy!

  • October 21, 2010 at 2:58 am
    GC says:
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    Cassandra, Cassandra, Cassandra. The only sheep here is YOU. The sad part is you don’t even see it, do you? Margaret Thatcher once said, “The problem with Socialism is that you eventually run out of other people’s money.” That’s the thing about the facts for people like you -they get in the way of your ideology. That’s all right, dear. Reality and truth always have a way of catching up. One day you’ll actually see the truth and realize how you’ve been played for a fool and fallen for it – hook, line, and sinker. Best of luck until then.

  • October 21, 2010 at 3:11 am
    Cassandra says:
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    TYPICAL…just label anything and anyone. So today, it’s “socialist?” Gosh, you REALLY, REALLY, REALLY have drunk ALL the Kool aid, haven’t you?

    You miss the whole point, Elyot. People that have high blood pressure, dyplasic PAP smears, pre diabetes, osteoarthritis under treatment etc., have PRE EXISTING CONDITIONS and cannot secure health insurance or affordable health insurance if they find themselves in the private market. GET SERIOUS. You can’t be that unaware…..All those 30m people are all lazy or illegals? What planet do you come from?

  • October 21, 2010 at 3:17 am
    Cassandra says:
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    You never did answer….DID your 401K tank? Did your home’s value take a nose dive? Did the cost of higher education become pretty much out of reach without debting yourselfs or your kids? Did you wages remain flat or decrease? If not, than consider yourself lucky and probably one of those making over 1,000,000 year. If so, you are being systematically stripped of the things that provide the middle class with security…and I am sure that if you look more at root causes of these things, and be fair, you will see that your new bosom buddies in Wall Street had more to do with this than some illegal landscaper.

  • October 21, 2010 at 3:31 am
    GC's reality says:
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    Sure GC…sounds like you are in a fantasy land with your beloved John Boner and Mitch Mconnell. Check out the supposed critics of the stimulus who went behind the scenes to get a slice of the pie: Tennessee Republican Lamar Alexander spoke out against the bill on the Senate floor.

    “It is not temporary. It is not targeted. It is not primarily creating jobs. It is not a stimulus bill. It is mostly a spending bill,” he said.

    But Alexander later wrote letters to the Transportation Department seeking stimulus grants for local projects he said would spur job creation. What do you call that, GC?

    Half a year after the bill passed, Senate Republican Leader Mitch McConnell of Kentucky told CNN the stimulus was a big mistake.
    “I think we can fairly safely declare it now a failure,” he said. Sounds like you, GC. But that fall he wrote the Transportation Department endorsing a state application for stimulus funds for a rail project. Do as I say, not as I do??

    The economy was in quite a state in 2008, GC. It takes a lot to turn it around. Even a half-@ssed economist knows that employment lags in good times and bad….It’s a bit early to judge the measures the fix the economy a failure. Stop the hyperbole and do some research, will ya?

  • October 21, 2010 at 3:35 am
    Elliot's world says:
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    Healthcare for the masses in this country consists of the following: Rich people who can afford it (no criticism there – people deserve to be rich if they earn it), people with insurance, and poor people who go to the ER for the sniffles or worse. Who foots that bill? Everyone else. Great system. Let’s do nothing. Maybe it will get better on it’s own.

  • October 21, 2010 at 3:37 am
    GC says:
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    Oh – you go to the same school that Cassandra goes to – I see! Not sure what TARP has to do with the Health Care Bill and how it affects insurance, but I don’t recall ever saying that I am a huge fan of too many Republicans that are currently holding office. And I wouldn’t be too quick to tell others to do research when you’ve clearly only done one side of your own.

  • October 21, 2010 at 3:39 am
    GC does no research says:
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    All I need to know I get from Carl Rove and Fox News – GC

  • October 21, 2010 at 3:40 am
    I like Cassandra says:
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    You GO girl!

  • October 21, 2010 at 4:01 am
    Elyot Spitser says:
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    Lazy, illegal or don’t want to spend their money on medical insurance when they can just go to ER and get treated at the taxpayer’s expense. The people you describe most certainly can get medical insurance subject to a 12 month pre-existing exclusion. The sooner they get the insurance the sooner the waiver goes away! There are 250,000 people with tragic diseases like muscular dystropy or cystic fybrosis that cannot obtain medical insurance. They need the help.

  • October 21, 2010 at 4:15 am
    Elyot Spitser says:
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    Using Cassandra’s logic, we should start allowing drivers with several DUI infractions or at fault DUI death accidents drive with no insurance because they cannot afford it, or we good drivers should pitch in and pay for it.

  • October 21, 2010 at 4:21 am
    UBU IBME says:
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    Cassandra’s hit the nail on the head.
    It’s also worth remembering that the health care reform passed this year is pretty much the alternative health care plan the Republicans put on the table in the early 1990’s when the Clinton plan fell flat on its face. Right down to the mandate for everyone to purchase health care- the concept came from conservative economic think tanks in an effort to ensure there was a market-based solution to providing health care.
    It’s also worth noting that Japan & Germany have private health care that works well and covers everybody at reasonable rates. What makes it possible, is the health care insurers are heavilly regulated, and the government imposes a mandate that everyone must purchase the coverage.
    The hyperbole and demagoguery thrown out there by the right wing does nothing to advance the debate or solve the problem. When you accuse one side of wanting to kill granny and grand dad, you’re not having a serious conversation.

  • October 21, 2010 at 5:06 am
    Cassandra says:
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    THANKS for comments, UBU IBME and others…sometimes I feel like a lone voice in the wilderness!

    Maybe the folks with “the other point of view” will realize that there is a vast group of people who do not think that everyone who does not have health insurance is lazy and shiftless, that every program intended to promote some kind of safety net is not socialism, and every industry excess can be curbed by the “free market.” The “free market” isn’t free and it don’t work when the deck is stacked.

  • October 21, 2010 at 5:25 am
    Cassandra says:
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    Your DUI comment was just so inane I was going to ignore it, but then I thought that this is just another argumentative ploy…turen the subject to the irrelevant and inane in an attempt to win the argument…the straw man.

    Do you have any clue at all at how inane that comment was? Any clue?

    I do love your cavalier attitude….”they can wait and get insurance after the 12 month pre existing condition is met”…WHAT PLANET ARE YOU REALLY FROM? Don’t you know it doesn’t work that way in the private market?

    And the gem about “they can go to the emergency room and get treated”….oh sure….check into the emergency room for your chemo treatments. I hear they do radiation treatments there too. What world do you inhabit? you must lead a very sheltered life. ER rooms will do EMERGENCY care but not long term care or critical care for chronic illness. But that’s OK…let them suffer they were probably illegals who are lazy and who just didn’t want to spend the money from their minimum wage job on health insurance.

  • October 22, 2010 at 10:07 am
    Elyot Spitser says:
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    I don’t know how you knew I went to Univ. of Virginia but thanks for the Cavalier comment.
    I am from Earth, I work in the insurance industry, and private medical insurance can and does work that way.
    If you did any research on the subject, you would know that there are federally funded clinics and hospital programs that take of people with tragic illnesses such as cancer, who have no insurance. You just have your socialist head so far up the democratic machine you can’t or choose not to see what’s going on.
    All I am saying is that there are alot of people who could get medical coverage but chose not to. That’s their dice to roll.

  • October 22, 2010 at 10:34 am
    Patriot says:
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    I’ve read through the Cassandra responses which remind me of the typically one sided socialistic viewpoint that all evil is created by Wall Street. You seem to conveniently forget the financial crisis started with Freddie and Fannie which have already cost taxpayers $175B and is projected to be $400B to $500B. Politicians like Frank and Dodd thought it was a right not a privilege to own a home. All health care insurance rates, rules and forms are reviewed and eventually approved by each respective state insurance department. Banks were forced to lend to less than qualified applicants through the Community Reinvestment Act. I could go on forever with other examples of what happens when the Government gets involved. If you believe the health care system is in trouble now you have not seen anything yet.

  • October 22, 2010 at 1:08 am
    Cassandra says:
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    There is simply no point in going on and on forever, patriot, because you still mouth the same old garbage. So, like knowingly secutritizing and bundling over and over and over again vehicles that contained toxic loans had nothing to do with anything? Don’t you realize that had that not been done, the original poor loans would have been 1/7 their value….before they were kited and kited and kited and churned and churned and churned by the wizards of Wall Street? Not to mention the bankers that knowingly made poor loans or the mortgage brokers that bent the facts so they could get commissions? But no, this is ALL the fault of Frannie and Freddie? No way; it is the fault of those that perverted the original goals of those no matter who they were or are. the fact that banks could dump off their poor decisions on the taxpayer, get free of any consequence, and move on had nothing to do with anything?

    How can I take anything you say seriously when you persist in this blindness?

    Get a life and get some facts; even some of your right wing wild eyed partisans agree with what I just said.

  • October 22, 2010 at 1:24 am
    UBU IBME says:
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    Cassandra- you notice none of our colleagues on the right have addressed the point that other countries have a completely private health insurance program which covers everyone at a reasonable price. These screeds about socialist take overs are nonsense, especially given that what we have is essentially Repubulican health care circa 1992. This is not a government take over of health care- it’s a corporate take over of health care. None of these doctors are working for the government; government agencies aren’t buying up clinics and hospitals. This is the private sector health care the Republicans said they wanted- in 1992.

    I don’t think they would know what a socialist was, even if one came up and bit them on the butt.

    Kudos for hanging in there & standing your ground on this pointless banter with the ditto heads.

  • October 22, 2010 at 2:09 am
    Patriot says:
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    I see from your respective posts you never state facts. Since you both waive the flag for the European and Canadian socialized health care systems please do some research and you will understand that when comparing American survivals rates for most types of cancer versus Europe,the USA has much better survival rates. Please read below or do your own research before posting:

    U.S. patients have better survival rates than European patients for most types of cancer, according to a new study. The research also shows that as the age at cancer diagnosis increases, survival tends to decrease in both the U.S. and Europe, but more so in Europe.

    The study published in the journal Cancer (Vol. 89, No. 4) reports on the survival rates of 738,076 European and 282,398 U.S. patients who were diagnosed between 1985 and 1989. A multinational team looked at survival rates for 12 different types of cancer, including lung, breast, stomach, colon, rectum, melanoma, cervical, uterine, ovarian and prostate. Only people with primary, first occurrence malignant tumors were included in the study. The researchers compared patients of similar age who had same type of cancer but race was not taken into account.

    How the Study was Conducted

    Data came from the National Cancer Institute’s (NCI) Surveillance, Epidemiology and End Results (SEER) program, which includes information on about 10 percent of those diagnosed with cancer in the U.S. Its European counterpart, EUROCARE, provided data from 17 European countries.

    Using complex statistical methods, the researchers calculated survival rates for each type of cancer for both groups. The results show Americans have significantly better five-year relative survival rates for cancers including:

    prostate (81 percent vs. 56 percent);
    melanoma (86 percent vs. 76 percent);
    colon (60 percent vs. 47 percent);
    rectum (57 percent vs. 43 percent);
    breast (82 percent vs. 73 percent), and
    uterine cancer (83 percent vs. 73 percent).

  • October 22, 2010 at 4:40 am
    Insurance 101 says:
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    I do not believe health care is a right for all to have. I do take issue with what to do with the cronic and the super ill. It is a sad day when you come down with somthing and can not go to work. Let’s say you are given less than a year to live. You are sick as a dog and can not function. You lose your job. Now you do not have health care. What now?? WHat is we set up a plan much like flood insurance. Call it a nationalized cronic and fetal illness plan. The plan is set up for those that would other wise not keep health care and need treatment. Every policy can have a premium tax (I know I hate taxes)and this premium tax go into a national pool. Now we remove a big portion of the librals agrument and save a few families at the same time. God bless this country!!



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