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Medigap Policies Face New Federal Nondiscrimination Rule
- Thread starter Yagents
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True, and carriers had an opportunity to fight Obamacare but they chose not to because of greed.
Everyone was required to have health insurance.
Underwriting would not be allowed which, presumably meant lower overhead and (possibly) bigger profits.
Agents no longer needed which meant saving commission dollars and keeping (almost) everything in house
From a carrier perspective, what's not to love about this gift from the federal government?
That's not what happened AT ALL.
The presidents of all the Blue's and the BCBS Association got called to DC in 2010, sat in some room for a while and the HHS Secretary (Sebelius?) finally walked in and said "Either play ball with Obamacare or lose the FEP program" and then she walked out.
It may be a contributing part of it, however . . .
BX was the primary carrier for FEHBP and probably still is. No doubt some testicles were squeezed but the other carriers could have fought it on legal grounds . . . namely McCarran-Ferguson.
FEHBP is a self-funded plan meaning carriers are just acting as a TPA.
Federal employees are currently numbered around 3 million . . . less than 2% of the total workforce. Federal workers have increased, not decreased, since 2010.
FEHBP is not the plum you think it is.
Several members of Congress also had their palms greased to encourage them to vote for this mess.
The cornhusker kickback, the Louisiana purchase, gator aid, Dodd clinic . . . the list of payola is almost endless.
If CMS decides to implement Obamacare rules in the Medicare market carriers, Medigap and MA, stand to lose a lot.
Carrier profits from MA are significant but the ancillary sales also generate a ton of revenue.
Medigap carriers don't get federal funding and their margins are small but they benefit considerably from ancillary sales.
Original Medicare and Medigap are not the same thing so it definitely is not splitting hairs.OM, medigap, now you're just splitting hairs
Go cry to your butt buddies, maybe they will care enough to tell how important it is for you to be right
So Medigap is definitely not federally funded.
But they want to (are going to?) apply a law created for federally funded programs to this non federally funded program.
Meanwhile, Medigap is having one of the biggest increase years in recent memory, while loss ratios in 2023 for medigap reached new heights.
Let's stress an already stressed (but vital) segment of the industry!
Fun times!
But they want to (are going to?) apply a law created for federally funded programs to this non federally funded program.
Meanwhile, Medigap is having one of the biggest increase years in recent memory, while loss ratios in 2023 for medigap reached new heights.
Let's stress an already stressed (but vital) segment of the industry!
Fun times!
@sshafran DC does a lot things that are not written in the Constitution, laws passed by Congress or contained in the regs.
McCarran-Ferguson was applied to individual health insurance plans until 2014 when Congress decided to ignore insurance laws that had been in effect since 1945.
Insurance is regulated by the states. This system of regulation stems from the McCarran-Ferguson Act of 1945, which describes state regulation and taxation of the industry as being in “the public interest” and clearly gives it preeminence over federal law. Each state has its own set of statutes and rules.
Obamacare usurped that law by mandating certain new "rules of the game" that were to be followed by health insurance carriers. With exception of antitrust laws, both insurance carriers and their plans were regulated at the state level.
As a result, a new taxpayer funded social welfare program was created. The result was chaos as of 1/1/2014 when that beast was hatched.
Obamacare was created by legislation and was only intended to apply to individual and group health insurance plans where those plans were the primary payor.
Ancillary and secondary payer plans were left alone by the law and the regs that were issued years after the law was passed.
FWIW, Obamacare was 2800 pages . . . regs that explain how the law was to be administered are 20,000+ pages.
Laws come from the legislative branch of government . . . regulations are the domain of the Executive branch which consist of appointed officials and their employees.
Regulation rules are not law. They are an interpretation of existing laws. Regs are not voted on but they can be challenged in court.
Also regs are not scored by the CBO and the bureaucrats who write the regs don't have to worry about how implementation will be budgeted. This is how we get in a financial mess!
Proposed changes to the WAY 1557 is expanded and implemented is a bureaucratic created problem that can only be stopped or modified by a political change at the top or by a legal challenge.
That's a long way of saying DC can effectively regulate Medigap plans by fiat until they are challenged. By the time the public is aware of what happened it will be almost impossible to roll back the clock.
ALL health insurance, not just Medigap, had higher than anticipated loss ratios in 2013 which is more of a blip than a trend. Premiums for insured plans are rising. Benefits are being cut and/or restructured. The 2024 plans and rates are different from 2023 and this will continue into 2025.
Most of the claim issues in 2022 and 2023 were a direct result of COVID restrictions imposed during the lockdown. Claims should smooth out a bit this year, partly because doctor visits are up vs the lockdown years and managed care plans are shifting more of the cost of treatment to the insured.
PAYING for health care via premiums or OOP has always been a challenge but perhaps even more so now because there are so many people struggling to pay for everyday living expenses and nothing left over to pay premiums or OOP health care costs.
One thing that is a given is this.
If 1557 is allowed to be implemented with regard to Medigap, that market will shut down almost overnight. Some seniors will gravitate toward managed care plans because of low/no premium but that will not solve the problem of funding large claims created by chronic or severe health problems.
The proposed 1557 changes are political. They are an answer to a problem that only exists in the minds of the bureaucrats.
McCarran-Ferguson was applied to individual health insurance plans until 2014 when Congress decided to ignore insurance laws that had been in effect since 1945.
Insurance is regulated by the states. This system of regulation stems from the McCarran-Ferguson Act of 1945, which describes state regulation and taxation of the industry as being in “the public interest” and clearly gives it preeminence over federal law. Each state has its own set of statutes and rules.
Regulation
Introduction Insurance is regulated by the states. This system of regulation stems from the McCarran-Ferguson Act of 1945, which describes state regulation and taxation of the industry as being in “the public interest” and clearly gives it preeminence over federal law. Each state has its own set...
www.iii.org
Obamacare usurped that law by mandating certain new "rules of the game" that were to be followed by health insurance carriers. With exception of antitrust laws, both insurance carriers and their plans were regulated at the state level.
As a result, a new taxpayer funded social welfare program was created. The result was chaos as of 1/1/2014 when that beast was hatched.
Obamacare was created by legislation and was only intended to apply to individual and group health insurance plans where those plans were the primary payor.
Ancillary and secondary payer plans were left alone by the law and the regs that were issued years after the law was passed.
FWIW, Obamacare was 2800 pages . . . regs that explain how the law was to be administered are 20,000+ pages.
Laws come from the legislative branch of government . . . regulations are the domain of the Executive branch which consist of appointed officials and their employees.
Regulation rules are not law. They are an interpretation of existing laws. Regs are not voted on but they can be challenged in court.
Also regs are not scored by the CBO and the bureaucrats who write the regs don't have to worry about how implementation will be budgeted. This is how we get in a financial mess!
Proposed changes to the WAY 1557 is expanded and implemented is a bureaucratic created problem that can only be stopped or modified by a political change at the top or by a legal challenge.
That's a long way of saying DC can effectively regulate Medigap plans by fiat until they are challenged. By the time the public is aware of what happened it will be almost impossible to roll back the clock.
ALL health insurance, not just Medigap, had higher than anticipated loss ratios in 2013 which is more of a blip than a trend. Premiums for insured plans are rising. Benefits are being cut and/or restructured. The 2024 plans and rates are different from 2023 and this will continue into 2025.
Most of the claim issues in 2022 and 2023 were a direct result of COVID restrictions imposed during the lockdown. Claims should smooth out a bit this year, partly because doctor visits are up vs the lockdown years and managed care plans are shifting more of the cost of treatment to the insured.
PAYING for health care via premiums or OOP has always been a challenge but perhaps even more so now because there are so many people struggling to pay for everyday living expenses and nothing left over to pay premiums or OOP health care costs.
One thing that is a given is this.
If 1557 is allowed to be implemented with regard to Medigap, that market will shut down almost overnight. Some seniors will gravitate toward managed care plans because of low/no premium but that will not solve the problem of funding large claims created by chronic or severe health problems.
The proposed 1557 changes are political. They are an answer to a problem that only exists in the minds of the bureaucrats.
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After reviewing dozens of scholarly opinions by legal and insurance experts, it seems that Allison is the only one saying Medigap plans will be subject to the new 1557 nondiscrimination rules.
The other articles speak to women's rights to abortion, and transgender rights.
The other articles speak to women's rights to abortion, and transgender rights.
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