Saturday, December 3, 2011

Mark This Day Down On Your Calendar...

...because this is the day seismic shifts in our health care system finally get under way.

Health insurance companies are finally going to have to provide health insurance coverage rather than spend all their money on things, like huge executive salaries, parties, planes, and other miscellaneous "overhead expenses".  Yes, today "we are now on an inescapable path to a single-payer system for most Americans".

Why?  How?  

The Affordable Care Act (ACA or Obamacare, take your pick), requires health insurance companies to spend 80% of the consumers’ premium dollars they collect—85% for large group insurers—on actual medical care rather than overhead, marketing expenses and profit. That's ACTUAL MEDICAL CARE!  

Failure on the part of insurers to meet this requirement results in the insurers having to send their customers a rebate check representing the amount in which they under spend on actual medical care.  So, they either pay for it, or send money back to all their customers.

The key, of course, is what qualifies as a LEGITIMATE medical care cost.  The Department of Health & Human Services is tasked with defining what insurers' expenses will quality.

Today is important because today the Department of Health & Human Services issues the rules of what insurer expenditures will—and will not—qualify as a medical expense for purposes of meeting the requirement.

It appears that HHS is taking their task seriously.  Insurance companies have been lobbying for months to be able to consider commissions paid for selling insurance as medical expenses.  HHS, today, said NO!  Paying someone to sell insurance is not an actual medical expense.  DUH!

So the question is can insurance companies survive on having to pay out 80% - 85% of their premiums for medical care?  Most are nowhere close to that now.

Medicare does, and a universal health care plan like Medicare For All will.

Extra Bonus:  Some more ACA good news.


  1. Hopefully the critics will be able to see what a good thing this is.

  2. How could anyone of average intelligence be against this concept. Of course they will survive and still make tons of money.

  3. really? Something good is actually going to happen???? Good to hear something good..

  4. I'm grateful we will FINALLY see an end to the nonstop parade of ridiculous lying TV ads from United Health to Humana to Allina and all the rest of those disgusting profiteers!

  5. I think Learjet payments and luxury vacations should qualify as medical spending. After all, a pampered HMO executive can make much more accurate business decisions after a relaxing ride in a Learjet and/or a 2-week vacation at a private spa in Tahiti.

  6. Jack's on the money with his comment. The Humanas and companies like it confuse hell out of people to trick them into shitty coverage that costs the most money.

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