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babylonsister Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Oct-21-10 09:14 PM
Original message
This is a BFD!
I'm stoked about this: GD-P, not so much. And :hi:, everyone!

http://www.democraticunderground.com/discuss/duboard.ph...

Health-Care Implementation Moves Forward.

http://www.prospect.org/csnc/blogs/tapped_archive?month...

Health-Care Implementation Moves Forward.

Today, an organization of state health-care regulators made an important decision. The Affordable Care Act mandated that 85 percent of each dollar patients pay their health insurers go toward actual medical costs, not business expenses or profit, but it didn't define medical costs. The state regulators voted to strictly define medical expenditures, so that insurers couldn't count their tax expenses, for example, as a medical cost. As with all major legislation, implementing the law is just as important as writing it in the first place. For more, check out the Prospect's recent special report, "Fulfilling The Promise of Health Care Reform," especially this article by top health-policy journalist Jonathan Cohn, which discusses this recent decision and other new rules for insurance companies mandated by the ACA.
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grantcart Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Oct-21-10 09:44 PM
Response to Original message
1. This is what is known as the Medical Loss Ratio


The MLR for private insurance is about 34%, and for single payer 4-6% so 15% is a huge step forward.

Now where in our economy can you find plans that have a MLR of 15%?

Plans for federal employees negotiated by OPM for all federal and postal employees.

OPM will be in charge of the new state plans.

If you go here you can see what those plans look like for federal employees. You have to add the government subsidy for FE to see what it would cost you but for most people it should be about a 20% reduction in cost because the MLR is being reduced by 20%.

http://www.opm.gov/insure/health/rates/index.asp
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babylonsister Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Oct-21-10 10:05 PM
Response to Reply #1
2. See, I knew it was a BFD. I'm not so familiar w/ins and outs,
and don't know that anyone cares about fed. employees, but the fact that the insurance co's didn't win this one is I think significant.
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TreasonousBastard Donating Member (1000+ posts) Send PM | Profile | Ignore Sun Oct-31-10 10:37 AM
Response to Reply #1
6. It looks like everything is going up, so where's the big savings? And....
who's paying for the OPM doing all this administering and negotiating? Acquisition costs are always much lower in a big plan, but they still exist-- someone has to enter and track your info somewhere.

Salaries, rent, phone bills, copiers... all have to be paid. The trick with Medicare is that other agencies pick up a lot of the bills. And the states pick up a lot of the Medicaid bills. And neither pays taxes.

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grantcart Donating Member (1000+ posts) Send PM | Profile | Ignore Mon Nov-01-10 01:02 AM
Response to Reply #6
7. further clarification

OPM is not going to do case management that is done by the health care provider.

OPM is going to examine and negotiate the total plans that go into the state exchanges. They are then going to have web sites where you go to find the plans in your area.

The additional cost?

Maybe a couple of million.

OPM is already doing this same function for federal employees, already has the skills and the software.

To see how it will work you can go here and pretend you are a federal employee. Put in your zip code and see the plans for federal employees in your area.

http://opm.gov/insure/health/search/plansearch.aspx

As for the savings the MLR for the health industry is about 35%. The MLR for Humanas which specializes in government plans is 18%.

Beyond that you have additional savings from the cost savings of scale and, even more importantly, you will be getting people to see a doctor early and deal with prevention instead of expensive corrective treatment.

For example free prenatal care will cost pennies on the dollars but it will have a dramatic impact on reducing premature babies and other problems that will save hundreds of billions. We have already seen this work by having immunizations.

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Cha Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Oct-21-10 11:52 PM
Response to Original message
3. Hiya, babylonsister!
Thank you for posting this BFD Important news in the BOG where it is APPRECIATED!

:hi: B-)
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babylonsister Donating Member (1000+ posts) Send PM | Profile | Ignore Fri Oct-22-10 08:06 AM
Response to Reply #3
4. Good morning, Cha!
:hi: You're welcome; I need to remember the BOG is here, but do so enjoy watching heads explode at good news 'up there'. :D
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nofurylike Donating Member (1000+ posts) Send PM | Profile | Ignore Sat Oct-23-10 01:37 AM
Response to Original message
5. this really is a BFD!! i just really got it. thank you for posting it! nt
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