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jrpike22.bsky.social
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Reposted by jrpike22.bsky.social
paleofuture.bsky.social
"An argument could be made that the medical loss ratio provision of the ACA has contributed to or even fueled the vertical integration of the big insurers, UnitedHealth especially."
An argument could be made that the medical loss ratio provision of the ACA has contributed to or even fueled the vertical integration of the big insurers, UnitedHealth especially. UnitedHealth is massively bigger and more profitable than it was on the day I first testified as a whistleblower, June 24, 2009, when it ranked 21st on the Fortune 500 list of U.S. companies. Its share price at the close of trading that day was $24.81. Hundreds of acquisitions later, UnitedHealth is now the fourth largest U.S. company — just behind Walmart, Amazon, and Apple. At the end of trading on Monday of this week, the share price was $560.62. That’s an increase of more than 2,100% since June 24, 2009. By comparison, the Dow Jones average has increased 438%. In the years since then, UnitedHealth, Cigna, and a handful of other New York Stock Exchange corporations have cemented their roles as unelected gatekeepers to care, and Americans are now waking up as they never have before to the consequences of that. If their rage can be harnessed and channeled, that dike the industry built might just give way.
December 12, 2024 at 4:05 AM
Reposted by jrpike22.bsky.social
paleofuture.bsky.social
Insurers must spend 80-85% of premiums on care by law. "But big insurers have figured out if they also become health care providers—by buying physician practices, clinics, and pharmacy benefit managers—they can meet that threshold by paying themselves and avoiding payment for their customers’ care."
As I explained to lawmakers — now more than 15 years ago — for-profit insurers like UnitedHealth and Cigna must assure investors and financial analysts every three months that they know how to control their health plan enrollees’ use of medical goods and services so that plenty of their premium dollars can be diverted to profits. Congress would ultimately include language in the ACA to require health plans to spend at least 80% to 85% of premiums insurers take in on enrollees’ care, known as the medical loss ratio. But big insurers have figured out if they also become health care providers — by buying physician practices, clinics, and pharmacy benefit managers — they can meet that threshold by paying themselves and avoiding payment for their customers’ care.
December 12, 2024 at 4:04 AM