[vundercind]

I can’t begin to relate to seeing someone with a median income failing to donate to some particular go-fund-me as the same as choosing to head an organization that makes more money when people don’t get the health care they need, and overseeing operations that did that even more recklessly than the industry standard. One has taken on a business relationship already and is taking people’s money then screwing them, at a mass scale. The other just didn’t donate to a gofundme that may not even be legit and for someone they have no connection to.

Similar reaction for the other examples. I’m baffled that they look similar to anybody at all.

[edit] hold on, ok, another angle that may clear up why I’m confused: if my health insurer denies my legit claim, should I be more, less, or equally angry with the leadership of that company, or with every single person in the country who fails to donate to my resulting gofundme? I’m immediately inclined to wish horrible things on one of these groups, and to find the idea of wishing horrible things on the other confusing and repulsive.

[s1artibartfast]

There are laws enacted by our elected government (Democrats under Obama) that say exactly how much overhead is acceptable for a health insurance company, and all business expenses and CEO pay comes out of that portion. If they collect too much in premiums to and their profits exceed that percent, they have to refund the insurance members.

Health insurance has a fixed profit margin on claims paid. Denying claims costs them money. Pay 10 billion in claims and they make 2 billion. Deny half the claims and they make half as much.

look up that ACA 85/15 law

[vundercind]

There’s some nuance to this.

The ACA’s loss ratio rules don’t apply to self-funded plans (many large employers use these) even if they’re administered (and possibly re-insured) by a health insurance company, which is usually the case. Just doesn’t apply at all.

Certain plans also allow much lower loss ratios, like 60/40 for expat plans.

A provider that manages to have a lot of new plans in a given state in a given year is immune from loss ratios rules in that state, for that year. I don’t know how gameable this is but my WAG would be it’s only state insurance commissions preventing this from being the case in every state, every year, for every provider, and keeping it to only some states in some years for some providers (I bet the biggies manage to rotate their state[s] and have at least one most years)

So a company the only business of which is health insurance can easily spend far less than 80 or 85% of income on payouts, and only need maintain that ratio on some subset—possibly small—of the premiums it’s collecting.

I don’t know how the game of this affects decisions for insurers that also own providers, but I bet there’s something beneficial there and that’s why they’ve been snapping up provider offices for the last several years.

[justinclift]

Not sure how this is relevant?