They didn't use those words, but that's what they're saying, nevertheless. There are two principles at stake here: First, that discrimination agai
July 24, 2010


They didn't use those words, but that's what they're saying, nevertheless. There are two principles at stake here: First, that discrimination against sick people is a thing of the past; and second, that the days of cherry-picking insured groups are over.

Either insurance companies can get on board, or else they are begging for Lynn Woolsey's newly-revived public option to become the law of the land. They certainly appear to be crying out for one. Here are a couple of stories that prove the point:

Insurers stop writing policies for children

This story could likewise be headlined "Insurers throw hissy fit, kick and scream on the floor, choose those least able to defend themselves as targets."

Nothing screams public option like screwing kids. Via MSNBC:

Some major health insurance companies have stopped issuing certain types of policies for children, an unintended consequence of President Barack Obama's health care overhaul law, state officials said Friday.

There's nothing unintended about it. It's purely the mean-spirited choice of insurers to lash back because they are about to be subject to laws which tell them they may not discriminate against people who are sick, or who might become sick sometime in their lifetime. It's neither a consequence, nor unintended. It's a sick, petty power game.

The administration reacted sharply to the insurance pullback. "We're disappointed that a small number of insurance companies are taking this unwarranted and unnecessary step," said Jessica Santillo, a spokeswoman for the Health and Human Services department.

Starting later this year, the health care overhaul law requires insurers to accept children regardless of medical problems — a major early benefit of the complex legislation. Insurers are worried that parents will wait until kids get sick to sign them up, saddling the companies with unpredictable costs.

The major types of coverage for children — employer plans and government programs — are not be affected by the disruption. But a subset of policies — those that cover children as individuals — may run into problems. Even so, insurers are not canceling children's coverage already issued, but refusing to write new policies.

That bold part in the middle is pure, unadulterated horse dung. Insurers aren't worried. They're behaving like two year olds, trying very hard to resist the inevitable -- an end to pre-existing conditions.

Their lobbyists might possibly be the biggest concern trolls that roamed this planet, eclipsing even Fox News and Elisabeth Hasselbeck in their phonied-up concern.

"Our plans are very concerned about this," said Alissa Fox, a top Washington lobbyist for the Blue Cross Blue Shield Association. "If the law says that insurers have to take you any time, any place, some people will see that as an opportunity to wait until their children get sick to buy coverage."

Insurers work hard to insert creative accounting rules into medical loss ratios

Medical loss ratios are pretty simple. Add up the costs to provide ACTUAL medical benefits against the money received in premiums and investment income. What is spent must be at least 80% of what came in. If it's more, insurers have to rebate the difference.

80% is generous. Medicare's MLR is 93% by comparison, and that 7% covers administrative costs only. Insurers were given an additional 13% leeway.

So when the New York Times reports this:

At stake, according to a report issued Thursday by Health Care for America Now, a coalition that supports the new law, is hundreds of millions of dollars when the law goes into effect next year. If the six largest for-profit insurers had had to meet the new standards last year, they would have been required to refund $1.9 billion, the coalition said.

The insurers contend that the advocates are discounting the value of an array of programs aimed at helping patients, which should be considered an aspect of quality improvement as part of the 80-cent minimum.

No. Not really, and let's be honest, brokers' commissions, expensive retreats, and "experimental programs" which can mean anything from weight loss initiatives to new computer/paperwork tracking software is really not part of the MLR.

These insurers need to be made to understand clearly that if Medicare operates on a MLR of 93%, they can manage with 80% and clear, understandable rules. It's a very bright line: Medical claims costs versus receipts. Period. End of discussion.

If they do not understand that, Lynn Woolsey has an answer for them, and every deficit hawk in Congress: A public option will take care of their concerns. Parents can sign their kids up for one, be confident that the MLR will not have any creative padding, and there will be no discrimination against people with pre-existing conditions.

So what's it going to be, Blue Cross/Blue Shield, United Health, Anthem, WellPoint, and the rest of you? Are you going to live within your means or are we going to force that ONE THING YOU FEARED MOST down your collective throats? Make no mistake, it can be done.

Behave like children, expect the adults to treat you like children.

cross-posted to

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