As a former health insurance exec who quit the business, let me tell you: No one will be more excited about the new COVID package than my old friends in the corporate insurance industry. It would funnel $48 billion of taxpayer $ to them, after their most profitable year to date.
The COVID bill would temporarily pay for ACA marketplace plans & COBRA subsidies for people who lost their jobs and insurance. That would check off a major item on insurers’ wishlist because it guarantees payment to our wasteful system that’s burdened by 30% administrative costs.
A more economical approach? Open our existing Medicare program (with a 2% admin. cost) for the Americans hardest-hit by COVID-19. This would allow folks to access the care many desperately need without Uncle Sam (you) footing a bloated bill.
For years, insurers & pundits have called for Americans to “put more skin in the game” when it comes to health care spending. With health care costs already at $3.8 trillion/yr and now a fresh $48 Billion windfall courtesy of taxpayers, there isn’t more skin for folks to give.
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(1/6) I just spent the last two weeks diving into the "Big 7" for-profit health insurance companies earnings reports for 2023.
It was pretty mind-numbing work. Hundreds of pages, decimal points and headaches.
But boy, oh, boy – as you will see – it was worth it. Let me explain:
(2/6) NEW ANALYSIS: In 2023, the Big 7 for-profit health insurers raked in a whopping $1.39 Trillion (up 346% from a decade ago!)
CEO compensation is up (totaling $136.5 million); Profits are up (totaling $70.7 billion); and stock prices are up for each of the Big 7.
But how?
(3/6) The Big 7's meteoric rise in revenue, profits and stock is thanks to taxpayer-funded programs like Medicaid, Tricare & Medicare Advantage, as well as their pharmacy benefit businesses.
But interestingly: what's NOT (way) up is their commercial health insurance businesses.
(1/6) NEW DOC: “American Hospitals: Healing a Broken System,” a documentary I helped produce, is being released everywhere on 11/10.
Anyone who's had to go to a hospital in the last 5 yrs will find this documentary particularly insightful. Let me explain: fixithealthcare.com
(2/6) "American Hospitals" details the unequal fortunes of U.S. hospitals – how a few tax-exempt hospitals are sitting on mountains of cash and paying their execs millions of dollars, while others serving rural + urban Americans have closed or are on the verge of being shuttered.
(3/6) No where are these hospital disparities more clear than Pennsylvania.
The Philly Inquirer reported that Children’s Hospital of Philadelphia paid its CEO, Madeline Bell, a record $7.7M in 2021 (more than the hospital spent on charity care in 3 yrs). inquirer.com/health/chop-no…
(1/4) AMERICAN DISGRACE: Mary Lou Retton, America’s first Olympic gymnastic gold medalist, is the new face of an American disgrace – millions of Americans are now buried under medical debt and must turn to crowdfunding campaigns to stave off collectors and get the care they need.
(2/4) Retton, once an Olympic icon, joins nearly half of Americans that struggle to pay their medical bills and it is not just the uninsured; even those with insurance are going bankrupt. kff.org/health-costs/i…
(3/4) And while millions of Americans struggle, UnitedHealth Group just reported $8.5 BILLION in profits in 3 months.
When it comes to insurance companies like UnitedHealth, it's clear that their incentives lie with enriching shareholders, not reducing the burdens on patients.
(1/6) ICYMI: Brookings Institution & The Wall Street Journal shined a light on Pharmacy Benefit Managers (PBMs) in health care. Researchers warned that while bipartisan legislation seeks to reform PBMs, insurers will likely find new ways to protect profits.
Let me explain:
(2/6) Brookings researchers rightfully put the PBM debate in the broader context of "market failure" in US health insurance – thanks to health insurers (and PBMs) relentless quest for profits at the expense of patients and employers. brookings.edu/articles/a-bri…
(3/6) The need for more competition in the PBM space is evident. Currently, three giants—UnitedHealth, Cigna, and CVS/Aetna—control ~80% of the market, giving them excessive power.
Greater competition could curb their profits, even if it's just by a few percentage points.
(1/5) Elevance had one of the highest denial rates among MCOs, according to the OIG.
And no where are these high denial rates more clear than in Ohio, Virginia and other states where Elevance manages taxpayer-supported Medicaid and Medicare Advantage plans.
Let me explain.
(2/5) More than 1-out-of-7 Medicaid beneficiaries in the U.S. is now enrolled in a plan managed by Elevance.
One way insurers avoid paying claims in both their MA and Medicaid businesses is by refusing to cover treatments and medications patients’ doctors say are necessary.
(3/5) For example, in Ohio and Virginia, Bon Secours Mercy Health, a big hospital system that serves many Medicaid patients, says Elevance owes it $100 million in late and unpaid claims.
This has caused a huge rift between Elevance and BSMH. And Medicaid patients will suffer.
(1/7) LATEST: Cigna released its Q2 2023 earnings report – the company made billions but it still disappointed investors.
As a former Cigna exec, I know that Cigna's C-Suite is scrambling to find ways to get back into Wall Street's good graces.
Let me explain:
(2/7) While revenue from customers increased in Q2, profits took a dip. The medical loss ratio (% spent on claims), inched up, triggering concern by Wall Street – dropping the stock price 4%.
And when it comes to executives at big health insurers – stock price is everything.
(3/7) Top executives at Cigna and other big insurers are deeply invested in stock performance.
Cigna CEO David Cordani and others face personal financial impacts when stock prices falter because their compensation is directly connected to stock performance.