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Health giants try goal-line stand

By Jay MacDonald ·
Tuesday, August 3, 2010
Posted: 9 am ET

Having lost the battle to block health care reform, the nation’s health insurance giants have retrenched in an effort to reduce how much the revolution is going to cost them. At issue: that nagging requirement that they spend 80 percent of the premiums they collect on the welfare of patients. If they fall short of that mark, they must refund the difference to consumers.

According to The New York Times, health insurance companies Aetna, UnitedHealth Group, WellPoint and others are lobbying hard to shoehorn the costs of things like ferreting out medical fraud, funding experimental studies and checking physician credentials into the regulatory definition of patient welfare. Some also would like to exclude the sales commissions they pay to agents and the taxes they pay on investments from their premium totals in order to whittle away further at that 80-percent figure.

The health insurance companies maintain that without such concessions, the 80-percent solution will result in both higher costs and lesser care for consumers.

Supporters of the new health care law accuse the health insurance companies of attempting to disembowel the 80-percent solution, aka the medical loss ratio, a key consumer protection provision. “They’re working every angle of the implementation process to shirk their obligations under the new law,” said Sen. John D. Rockefeller IV (D-West Virginia) in a statement.

All sides are eagerly awaiting the regulatory recommendations of the National Association of Insurance Commissioners, comprised of state insurance regulators, that is expected to hit the desk of Health and Human Services Secretary Kathleen Sebelius as early as August.

What’s your bet? Will the health insurance giants succeed in their goal-line stand of the bottom line? Or will the regulators side with patients over profits?

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