Aetna Leaving Obama Care

[wolf39us]

http://finance.yahoo.com/news/now-know-real-reason-aetna-132900946.html

Well, it looks like Aetna lied. Big Surprise!  Aetna cited the large losses that the company has incurred from the exchange business â€"

$200 million in the second quarter alone â€" when explaining its decision to roll back its business.These statements, however, appeared to be a dramatic turnaround from the company's first-quarter earnings call in April, when CEO Mark Bertolini said the firm planned to stay in the exchanges and that the company was "in a very good place to make this a sustainable program.

"Now, however, it appears a large reason for the shift in tone was the Department of Justice's lawsuit to block Aetna's merger with rival Humana.

[stromboli]

http://finance.yahoo.com/news/now-know-real-reason-aetna-132900946.html

Well, it looks like Aetna lied. Big Surprise! Aetna cited the large losses that the company has incurred from the exchange business â€"

$200 million in the second quarter alone â€" when explaining its decision to roll back its business.These statements, however, appeared to be a dramatic turnaround from the company's first-quarter earnings call in April, when CEO Mark Bertolini said the firm planned to stay in the exchanges and that the company was "in a very good place to make this a sustainable program.

"Now, however, it appears a large reason for the shift in tone was the Department of Justice's lawsuit to block Aetna's merger with rival Humana.

If you think insurance companies suck, stick around. The older you get the more they suck.

[SGOS]

https://amp.businessinsider.com/aetna-humana-merger-reason-for-leaving-obamacare-2016-8

This makes three large insurers that have pulled out of Obamacare.  I'm not sure I understand the reasons.  Well, I understand them but I'm suspicious that the whole story is not being articulated.  This move sounds like it's meant to put pressure on the Department of Justice which is blocking Aetna's merger with Humana (one of the other large companies that has already pulled out of Obamacare).  From what I understand, Aetna could still profit, but in the short term, it will be involved with expensive litigation with the DOJ, which makes the expensive startup costs of Aetna expansions less profitable for the company's bottom line, or so they say.  If the Department of Justice backs down, it sounds like Aetna would stay in the exchanges, and even expand.  If they don't get their way, they can threaten to weaken Obamacare to the point of collapse.

If enough insurers pull out of Obamacare, it could cause the system to collapse, which could re-open the door to single payer legislation, but that's my pie in the sky hope.  Insurance companies don't want that, and Aetna and the others are sure to calculate that possibility into their strategies.  Obama's answer to health care, like the banking scams so far, seems to be centered around subsidizing private insurers, and I'd expect more incentives funded by taxpayers, possibly in the form of supposedly necessary "bailouts" to insure corporate profitability.  I also don't think Democrats in Congress want to revisit health care, either.  It's an ugly political battle, and Republicans would be sure to point to the failure of Obamacare and use that as a "therefore single payer would be even a worse failure" argument to muddy the waters even more.  In addition, politicians, including some Democrats are indebted to insurance companies, and have no intention of killing the golden goose.

For Republicans, they don't even have to indebted to insurance companies.  It's just good politics to use against Democrats, and single payer if it ever happens at all, will only be passed by a Democratic congress.

[Nonsensei]

My mother is a  VP for a major insurance company. Insurers are losing their shirts on Obamacare according to her. If it's not profitable they will stop doing it and there may be no more deep s reason than that.

[chill98]

https://amp.businessinsider.com/aetna-humana-merger-reason-for-leaving-obamacare-2016-8

Well, I understand them but I'm suspicious that the whole story is not being articulated.  This move sounds like it's meant to put pressure on the Department of Justice which is blocking Aetna's merger with Humana (one of the other large companies that has already pulled out of Obamacare).  From what I understand, Aetna could still profit, but in the short term, it will be involved with expensive litigation with the DOJ, which makes the expensive startup costs of Aetna expansions less profitable for the company's bottom line, or so they say.  If the Department of Justice backs down, it sounds like Aetna would stay in the exchanges, and even expand.  If they don't get their way, they can threaten to weaken Obamacare to the point of collapse.

If enough insurers pull out of Obamacare, it could cause the system to collapse, which could re-open the door to single payer legislation, but that's my pie in the sky hope.  Insurance companies don't want that, and Aetna and the others are sure to calculate that possibility into their strategies.  Obama's answer to health care, like the banking scams so far, seems to be centered around subsidizing private insurers, and I'd expect more incentives funded by taxpayers, possibly in the form of supposedly necessary "bailouts" to insure corporate profitability.  I also don't think Democrats in Congress want to revisit health care, either.  It's an ugly political battle, and Republicans would be sure to point to the failure of Obamacare and use that as a "therefore single payer would be even a worse failure" argument to muddy the waters even more.  In addition, politicians, including some Democrats are indebted to insurance companies, and have no intention of killing the golden goose.

For Republicans, they don't even have to indebted to insurance companies.  It's just good politics to use against Democrats, and single payer if it ever happens at all, will only be passed by a Democratic congress.

Aetna should not be trusted to stay in the exchanges with/without merger.  Humana already pulled out and it is likely, Aetna was just posing for the cameras when beginning the merger strategy and declaring it would be staying with the exchange.  I do not believe it is in the best interest of any for profit corp to stay involved with obamacare (looking at it from a profit only aspect).

https://en.wikipedia.org/wiki/Aetna

As far as Dem vs Rep, Obamacare had its chance for single payer.  At that time, both the house and senate were in democratic control.  They did not need the republicans to push it through.  Single payer did not go through because of democrat hesitation/obligation-to-corp contributors.

Obamacare is a disaster for the working poor/lower end of the wage spectrum.  It is basically a 10% wage cut for a product you cannot use because of deductibles.   Locally, the news has been doing reports on people insured getting extreme bills because, in my not so humble opinion, hospitals are deliberately placing out of network employees into these situations to increase their profits.  One local example was an $18K bill for a doctor in a different state watching and advising via skype and conveniently out of network.

I am not convinced the collapse of Obamacare would be a bad thing.

[wolf39us]

merged related topics

[SGOS]

merged related topics

That's good to know.  I got a notification that Nonsensei and replied to my other thread, and when I tried to access it via my email, I kept ending up in the shout box, so I just went to recent topics and found it in this thread.  I forgot this thread had already been started.  I know it's not a big deal, but I apologize for starting a similar thread.  Naw, not really, but I'm happy you combined the threads and eliminated the redundancy.  Naw, not really about that either.  I really don't care one way or the other.

Anyway, I feel validated by the other opinions here.

My mother is a  VP for a major insurance company. Insurers are losing their shirts on Obamacare according to her. If it's not profitable they will stop doing it and there may be no more deep s reason than that.

My first intuition might be wrong.  I hate to challenge your mother's claim, but I usually assume that losing their shirts means not profiting as much as they want.  But what I do know about insurance companies is that their business practices have continually shown up on the shady side of integrity.  This is mostly from NPR, which is the only life news feed that I get, since I don't have TV. 

Before I was on Medicare, I had Blue Cross at one time through my employer, and their first response was to try to screw me on a major claim.  It was for an emergency operation and long hospital stay for a severe bleeding ulcer.  They denied payment saying it was a pre-existing condition.  I had only been with that employer for 6 months at the time.  It was not a preexisting condition.  I never had a problem with an ulcer before that.  There was no record or source of information to justify their first response.  Later, I heard reports that many insurance companies were routinely rejecting claims using various bluffs to see if the claimant would buy it and leave them alone.  However, I hired a lawyer, and they stopped that bullshit after a couple of months.

Another insurance company, many years later, one which I actually liked, had all kinds of special rules you had to follow or the claim would be dismissed.  I fucked up once on a cancer operation, and didn't inform them prior to some expensive preliminary tests and they denied my claim, but I pleaded my case (which was ignorance of that rule), and they let me off with a warning.  I actually felt good about them understanding I was truly ignorant of the rule and having them decide to pay the claim.  Considering what happened with Blue Cross, I thought that was righteous of them.

Now I'm on Medicare, and I don't have to put up with that annoying insurance company wrangling.  It's good not to have to screw with insurance companies.  I hope this isn't too offensive knowing that  your mother is a corporate VP.

[Nonsensei]

That's good to know.  I got a notification that Nonsensei and replied to my other thread, and when I tried to access it via my email, I kept ending up in the shout box, so I just went to recent topics and found it in this thread.  I forgot this thread had already been started.  I know it's not a big deal, but I apologize for starting a similar thread.  Naw, not really, but I'm happy you combined the threads and eliminated the redundancy.  Naw, not really about that either.  I really don't care one way or the other.

Anyway, I feel validated by the other opinions here.

My first intuition might be wrong.  I hate to challenge your mother's claim, but I usually assume that losing their shirts means not profiting as much as they want.  But what I do know about insurance companies is that their business practices have continually shown up on the shady side of integrity.  This is mostly from NPR, which is the only life news feed that I get, since I don't have TV. 

Before I was on Medicare, I had Blue Cross at one time through my employer, and their first response was to try to screw me on a major claim.  It was for an emergency operation and long hospital stay for a severe bleeding ulcer.  They denied payment saying it was a pre-existing condition.  I had only been with that employer for 6 months at the time.  It was not a preexisting condition.  I never had a problem with an ulcer before that.  There was no record or source of information to justify their first response.  Later, I heard reports that many insurance companies were routinely rejecting claims using various bluffs to see if the claimant would buy it and leave them alone.  However, I hired a lawyer, and they stopped that bullshit after a couple of months.

Another insurance company, many years later, one which I actually liked, had all kinds of special rules you had to follow or the claim would be dismissed.  I fucked up once on a cancer operation, and didn't inform them prior to some expensive preliminary tests and they denied my claim, but I pleaded my case (which was ignorance of that rule), and they let me off with a warning.  I actually felt good about them understanding I was truly ignorant of the rule and having them decide to pay the claim.  Considering what happened with Blue Cross, I thought that was righteous of them.

Now I'm on Medicare, and I don't have to put up with that annoying insurance company wrangling.  It's good not to have to screw with insurance companies.  I hope this isn't too offensive knowing that  your mother is a corporate VP.

I'm not offended at all. Shes the compliance VP, which means it's her job to keep the company she works for on the right side of the law and on the right side of CMS.

I think what you experienced was standard procedure. Insurance companies often deny large claims initially and then when you insist they give in. Its not really meant to deny you coverage, its actually an attempt to spread out losses as much as possible. They basically moved the loss that is your insurance payment to a different part of the timeline which evens out spikes and stuff on the financial charts. Spikes look bad to shareholders even though, in the end the same amount of losses are accrued at the end of the year. Spikes can mean the underwriters are doing a poor job judging which risks are good and bad.

As to whether or not these large companies are really losing money or just not making as much as they want to, I can;t personally verify anything since I'm getting this from a second hand source but she told me they have lost "billions" on Obamacare since it was enacted. Doesn't sound like they're just being cranky. Sounds like they're terminating a bad buisness deal.

She has all sorts of facts on exactly why obamacare has been a financial loss for most insurance companies that I can't remember. If you want I can ask her to send me a more detailed explanation.

As a side note my mother actually worked for BCBS of Tennessee a few years back. They fired her mere months after hiring her, as part of a power play in upper management. Essentially the guy that hired her lost the power struggle and the winners didn't want her around. Pretty fucking scummy to begin with considering she picked up her life and moved it 1300 miles to work for them, but there was also sexual discrimination going on against her and she had it well documented. They knew it, and ended up paying her a quarter of a million dollars to just go away.

She took it because lawyers fees are a bitch. Point is, not all insurance companies are shit but I'm pretty sure BCBS is literally shit. In all ways.

[Baruch]

Any society that is going to spend an exponential amount of GDP on medical care ... is bankrupt.  It isn't just the insurance companies, it is the whole country.  The government can fund it temporarily, like a blood bank dumping ever great transfusions into a hemophiliac.  But in the end the patient dies anyway.  Health care is where modern civilizations go to die.

[SGOS]

She has all sorts of facts on exactly why obamacare has been a financial loss for most insurance companies that I can't remember. If you want I can ask her to send me a more detailed explanation.

Don't knock yourself out, but if it's not too much trouble, I would be curious about this.  I've assumed, but not without any factual data, that Obamacare was a windfall for insurance companies.  I based that assumption on the government forcing everyone to buy insurance, and subsidizing a large number of those who can't actually afford it.  While they eliminated the pre existing clauses, they claim that a huge number of previously uninsured are now buying insurance.  Supposedly, the previously uninsured young who don't need medical care are forced to buy insurance, but aren't expected to make many claims.  That was supposed to eliminate the need for doctors and hospitals to overcharge the uninsured and bring down medical charges across the board for all consumers, (I suspected that was bullshit, and that we would never see it), but on Medicare I really don't know what an office call costs anymore.  But it seems like all this would be good for insurance companies, and I always felt that Obamacare was passed instead of single payer because they were lobbied hard by the corporate world.

Incidentally, while Medicare is comparatively good, it still costs me almost as much as my employer was paying for my insurance when I retired 20 years ago.  That's because of out of pocket costs of Medicare part B and my AARP supplemental insurance.  But that's apples and oranges.  Medicare covers more, and so far, I haven't dealt with deductibles and copayments.  However, since I've been on Medicare, my out of pocket insurance costs are still greater than my medical expenses.  I don't have prescription drug insurance at all, so that's an out of pocket cost that I'm not figuring in.  Although, my prescription drugs are still minimal.  but I have talked to one guy who claimed to be taking some drug that costs $20,000 a month.  I hope I never see anything like that.

[AllPurposeAtheist]

Any society that is going to spend an exponential amount of GDP on medical care ... is bankrupt.  It isn't just the insurance companies, it is the whole country.  The government can fund it temporarily, like a blood bank dumping ever great transfusions into a hemophiliac.  But in the end the patient dies anyway.  Health care is where modern civilizations go to die.

Yeah Baruch, we'll all be sure to pray for you next time you get sick since you won't be using any sort of healthcare..

[Nonsensei]

The rates that the ins companies need to set to offset the cost of taking care of very sick people on obamacare are denied and cut by the insurance commissioners in the States in which the company operates in. Therefore, they can't make any profit and lose money. They (Aetna) lost $500M last year.

The commissioners have final say over the rates, and can lower them without having to explain. And they do.

Also, the risk pool of members on Ocare is much, much sicker than what was originally planned for. Healthy people are not signing up, leaving the ins companies to care for only very sick people, and with lower reimbursement rates.  That's a 'lose money by the truckloads" scenario. There is  penalty (on people who refuse to sign up) but the rates are so high, even with the commissioners holding them down somewhat, that it's cheaper to take the penalty. Rates are increasing by double digits. Average increase requested by ins companies this year is over 13%. The penalty is static, and was quickly overcome by the increasing insurance premiums.

[SGOS]

The rates that the ins companies need to set to offset the cost of taking care of very sick people on obamacare are denied and cut by the insurance commissioners

That is a strange partnership.  The regulating agency should have access to the corporation's records, and should know at a glance what rates are un-sustainable.  I did hear people talk about paying the fine instead of buying the insurance, but I thought it was just grumbling.  The fine would have to be significantly lower than the rate for most people to take the risk of being uninsured.  I can understand going with the cheaper option, but in the face of catastrophic risk, it would have to be way cheaper. 

Obamacare is completely different than any healthcare system so far devised.  It's like congress rejected workable programs currently in use, and in their ultimate wisdom, thought they could build a better program.  Although, most Americans don't seem to like Obamacare, some because of it's shortcomings, and some because they would never give Obama credit for anything.  Maybe the government can force it to work, but more than likely, they probably don't care.  The debate is over, the law has been passed, but it's hard to continually advocate for something that has been so half-heartedly received.

[SGOS]

The rates that the ins companies need to set to offset the cost of taking care of very sick people on obamacare are denied and cut by the insurance commissioners in the States in which the company operates in. Therefore, they can't make any profit and lose money. They (Aetna) lost $500M last year.

The commissioners have final say over the rates, and can lower them without having to explain. And they do.

Also, the risk pool of members on Ocare is much, much sicker than what was originally planned for. Healthy people are not signing up, leaving the ins companies to care for only very sick people, and with lower reimbursement rates.  That's a 'lose money by the truckloads" scenario. There is  penalty (on people who refuse to sign up) but the rates are so high, even with the commissioners holding them down somewhat, that it's cheaper to take the penalty. Rates are increasing by double digits. Average increase requested by ins companies this year is over 13%. The penalty is static, and was quickly overcome by the increasing insurance premiums.

Listening to NPR while driving today, these specific points were all confirmed by the guests on "Fresh Air" or maybe it was the Diane Reams Show.  Also, apparently Obama was quoted saying, "It may be time to revisit single payer."  That sounded like an indirect way of admitting defeat.

[Baruch]

Yeah Baruch, we'll all be sure to pray for you next time you get sick since you won't be using any sort of healthcare..

You and the Single Provider can kiss my healthy ass ;-)

I am a human being, of infinite worth, and socialist ... so I claim all your quatloos ... because I am needy.

The Soviet Union of medicine will save you.  France has good public health care ... because they don't pay for Nato.