Monday, January 02, 2012

Is it the Mandate or the Medical Loss Ratio?

What's really behind Republican contempt for what everyone from Michele Bachmann to Mitt Romney like to call "Obamacare?"

Is is that the Affordable Care Act, passed and signed into law in 2010, contains a mandate for individuals who have the wherewithal to carry health insurance or face a penalty as many opponents claim?

Or, is it something else, a factor that has yet to be mentioned during any of the Republican debates, and something that will be conspicuously absent from any discussion of the results of Tuesday night's Iowa caucus: the medical loss ratio.

As a December article in Forbes explains, thanks to Obama's health insurance reform legislation, insurance companies must spend roughly 80% of a patient's premiums on the patient instead of pocketing the profits. http://

So, are candidates for the Republican presidential nomination really worried about the government mandating health coverage, or is their real concern that a provision in the fine print of the Affordable Care Act will cut into for-profit health insurance by Health and Human Services oversight into how the premiums are spent.

Any Republican presidential wannabe, like Newt Gingrich, who has tried to establish his own for-profit health insurance wouldn't like so-called Obamacare because it means, as the Forbes article asserts, "that the insurance companies spend what they should taking care of their customers" instead of looking for ways to siphon off premiums to cover their overhead, and/or to put a new BMW in a sales executive's garage.

Last month, too, the Department of Health & Human Services ruled on what qualifies as legitimate medical expenses and effective immediately, for profit, private insurance companies have officially joined the endangered species list.

The Affordable Care Act has been roundly condemned by both the right and the left. Many progressives lament this administration's capitulation on the public option.

Others would like to see a single payer system. But, those who read the fine print will see that, over time, the medical loss ration will erode and eat away at private insurance companies' bottom line such that private insurance companies will eventually exist only to cater to the upper 1% of the population while the other 99% of us will have access to affordable health care and the assurance that 80% of the premiums we pay will go exclusively into our care, and not into a health care executive's sales bonus.

So, from now until November, 2012, whenever you hear any Republican candidate, esp. Mitt Romney, talk about Obamacare, instead of thinking about the individual mandate think about the medical loss ratio. This is what those Republicans wrestling each other for to be the next president are really concerned about.

As you know, the universal health care plan Gov. Romney got passed in Massachusetts, upon which the president's health reform legislation was based, which won enthusiastic approval from Newt Gingrich, contained a mandate requiring individuals who can who can afford to acquire health insurance to do so.

And, you can bet that no plan would be approved by Corporate Mitt that would require 80% or more of premiums to be spent only on patients. After all, Romneycare was intended to be a booster shot for the private insurance industry, and not a way to deal with the working poor.

How Romney dealt with the poor and working poor in his state was to veto provisions of his health care law that would have given dental benefits to those who were on Medicaid.

And, for those who believe Romney, during the Republican debates, when he says this country was founded by immigrants, how much he respects immigrants who are here legally, keep in mind that he also opposed providing any health coverage at all to legal immigrants who were not eligible for federal Medicaid, even those who were seniors, and/or disabled.

What a statement about where we are as a country when someone like Mitt Romney can be considered a moderate in any party?

Romneycare was essentially the Massachusetts legislature's gift to private insurance companies in that state. Make no mistake. Romney has read the fine print. When he talks about wanting to make his first official act as president the elimination of so-called Obamacare, Romney isn't interested in getting rid of a government mandate that forces you to buy health insurance, but instead he wants to overturn a provision that stops private insurers from pocketing your a larger percentage of your premiums for their own personal use.