Cracking Down on Health Insurance Companies

[somarco]

However, I can't say that I disagree with the idea of at least reviewing rate hikes over 10% to see if they are justified.

Doesn't matter if you agree or not. It is going to happen.

I maintain there is no need for such oversight, or MLR either. The FREE MARKET decides if the price is right or not.

I spent the first 20 yrs or so of my career working for home offices and reinsurance carriers. I am not an actuary or underwriter, but I have seen enough loss reports over the years to know the current regulatory environment is bullsheet.

Doesn't really matter what I know or believe. The inmates are running the asylum in DC.

 

[Crabcake Johnny]

And, I disagree. The free market can't decide. I won't name a now defunct insurer that annually meted out 30%+ rate increases which amounted to nothing more than a financial trap for people who couldn't cancel due to a health condition. Some of these companies lasted for years - 5, 10, 20...

The "free market" failed those policy holders and it's nice to see some pressure applied. Do you also notice a complete lack of carriers going mental over this? It's near radio silence. Why? Because they're all doing just fine. They can't whack everyone with 18%? Oh well - good while it lasted - rate increase this year is magically 8%.

 

[somarco]

The free market works fine.

Many times agents fail to serve their client base and get caught in a trap and are forced to churn their business or lose it.

I have been doing this for a long time. I rarely lose clients, rarely have to move them to a new carrier or plan.

Most of my clients stay on the same plan and carrier for probably 5 years.

When you pick the right plan and carrier for your client you don't have to churn.

Sadly, most agents never learned how to manage a block of business.

 

[Crabcake Johnny]

The free market for health insurance is a total cluster f**k. If you got insurance through your job - great. If not it's off to the individual market. That's not saying that your group coverage was anything to sing about.

If you did not qualify for insurance there was no price you could pay to obtain it. Just "declined." Most states did not have risk pools to address the issue. Reference FL - risk pool tanked.

Carriers don't simply decline in large medical issues, but smaller issues. I had an "all carrier decline" a few years back because a lady had two UTI's in a single year. Thank God I had MHIP or she wouldn't have been covered. That's retarded - to put it mildly.

I got rated 15% for acne rosacea. Why? I had a formal diagnoses for it years back. What's my treatment? Soap that doesn't contain perfumes. No meds. Still got rated. Some actuary is gonna show me stats where my rosacea "could" be justified by a 15% total premium increase? Bullshit.

That's nothing more than abusive. My wife got rated for having a C-section WHILE they excluded her for future c-section deliveries. So wait...why rate for a c-section if you're gonna rider future c-sections? Abusive.

If you deem that as "the free market working" I'd hate to see your definition of failure.

How did the "free market" address a self-employed diabetic who owns a business in a state that didn't have a "group of one" product? It didn't and that person was ass-out.

 

[Dave020]

Problem's in the numbers, Johnny. Employer plans have participation mandates, individual market does not.

No way you can make anything work well with the following numbers:

CA - 2.1M on IFP, 8.1M uninsured (steady 6.3M)
USA - 16.7M on IFP, 60M uninsured (steady 47M)

Fix participation, you fix the problem, at least to a degree. Those numbers tell a very serious story. The only people who want to buy an IFP plan are the few who are responsible and a whole bunch of very unhealthy people. In the middle there is a huge group of "could be coverds" who just don't want to.

Why did CA PCIP go broke with enrollment of less than 23% cap of original target?? Exactly.

 

[Crabcake Johnny]

Well that's exactly my point. The free market does not work for health insurance.

 

[GreenSky]

Well that's exactly my point. The free market does not work for health insurance.

Just when have we had a free market for health insurance? I seem to notice a TON of regulations that have added at least 25% to the price of insurance.

I know you want single payer, but when that happens you'll be the 2nd person in this venue to bitch.

Rick

 

[Crabcake Johnny]

Before health care reform the individual market was regulated? In what way?

 

[GreenSky]

Before health care reform the individual market was regulated? In what way?

John, for you to ask that question is amazing. Guess the state legislatures adding more and more mandates, rate approval, GI for 2+ groups, etc. wasn't regulation?

I know you have the knowledge to know better.

rick

 

[Crabcake Johnny]

John, for you to ask that question is amazing. Guess the state legislatures adding more and more mandates, rate approval, GI for 2+ groups, etc. wasn't regulation?

I know you have the knowledge to know better.

rick

Association plans side-stepped almost all of those state regulations, especially prior rate increase approval.