I figured out what Healthcare.gov is hiding.
ACA (Obamcare) has a requirement that every state (including those with state run exchanges) offer two “multi-state” groups of plans that have a uniform benefit structure in every state, overseen by Federal regulators and with a separate risk pool. The Office of Personnel Management (OPM – see OPM money!) was tasked with qualifying companies that wanted to do this – the thought was that the OPM can be persuasive in coercing companies that currently cover federal government employees.
One thing written into the law for fairly obvious reasons is that at least one of the multi-state insurers must offer a plan that does NOT cover abortion.
Blue Cross/Shield is the only company that agreed to be a multistate provider (and that doesn’t mean all 50 states). In September, the news had quietly reported that the OPM had no signed commitments. The BC/BS contract was signed on September 30th.
What this means is that in many states, if you did get to the “show me the plans!” page, the only thing listed would be Blue Cross/Shield. In some states, there may be no company listed.
Blue Cross / Blue Shield organizations are non-profit and generally have higher costs to consumers than the major for profit competition.
Part of the ACA (already in effect) requires that the amount paid for claims must be at least 80% of the premiums. I bet not one is over 80.000001%
Employees get a salary and a bonus. You can bet the total bonuses will be determined to manage to that number.
Likewise, provider’s contracts can also have a variable cost component, but that defeats the purpose of reducing medical costs.
Really clever people could figure out ways to “pay costs” that somehow wind back in the treasury in an unregulated subsidiary like loaning money to the hospitals at very high interest rates through a private placement
This two part article tells you all you need to know about that…..
http://www2.metrotimes.com/editorial/story.asp?id=4462
http://www2.metrotimes.com/news/story.asp?id=4494
The writer of these very accurate and informative pieces just got fired…..
http://www.deadlinedetroit.com/articles/6255/metro_times_fires_veteran_staffer_curt_guyette_–_for_talking_to_the_press
They could do that. Or sell analysis and data back. Success rates for different treatments, facilities, and providers, for example.
Better still, the data work can be done by a subsidiary that is off shore and in a low tax jurisdiction.