It’s the insurance companies fault…again

A recent release by CMS says that the growth in health care spending in Obamacare plans was very modest, almost non-existent, (although the way they state the information is questionable) between 2014 and 2015; in fact lower than among individual plans.

According to today’s report, per-member-per-month claims in the individual market were essentially unchanged from 2014 to 2015, falling by 0.1 percent. Indicators of per-member cost growth in the broader private insurance market (such as employer coverage and Medicare) rose by 3 to 6 percent in 2015.

Exactly what are claims? Do they mean claims filed or the actual cost of health care provided? And why per member? It’s just a strange way of trying to relate the total cost in health care spending for a group. An influx in new members could lower the per member cost, but there could still be a significant increase in spending. 

Their rationale for the high proposed 2017 premium increases is that insurance companies set their premiums too low in 2015 and must play catchup.

What a joke! The federal government and state regulators have been applying pressure for lower premiums since the first Obamacare enrollment. If insurers had requested higher premiums to cover expected claims, what are the chances they would have been approved?

Of course they must play catchup, wouldn’t you or would you run your business with the intent of not covering your costs?


2 replies »

  1. When the developers of Obamacare were cooking up the legislation, I remember reading that many leaders in the health insurance industry were consulted and sold the bill of goods that they would have millions of additional paying customers, many of whom would be in the low health maintenance mode, ie, young, healthy, working men and women.

    The health insurance industry was more or less complicit in the passage of the legislation. They were, as they say, co-opted.

    Now, as companies analyze their profit and loss, many have either pulled out of states altogether, or reduced the number of counties where they offer coverage.

    The semi-free market is moving forward, albeit with a flat tire, or two.


    • It would appear everyone overestimated the desire for insurance, how people define “affordable” and the effectiveness of the penalty for not having insurance. The fact they had to have various reinsurance programs in the first place should have been a clue.


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