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Leo W. Gerard

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Obamacare Pays Off - in Real Cash

Posted: 05/07/2012 8:30 am

In a famous Laugh In sketch, Lily Tomlin, playing arrogant operator Ernestine, telephones a customer to demand payment of $23.64 for three calls to Topeka and threatens to send a burly serviceman to the customer's house to rip his phone out of the wall if he doesn't pay.

Ernestine was the face of smug and uncaring Bell Telephone. Today, she'd be the mug of cocky and cold-hearted health insurers.

In the 1960s skit, when the telephone customer complains about Ernestine having access to his confidential financial and tax records, she says of the telephone company:

"We are not subject to city, state or federal regulations. We are omnipotent."

Back in the days of Laugh In, the customer who Ernestine wrongly accused of owing $23.64 had no recourse. Today, however, because of Obamacare, the client could call Ernestine and demand a refund. Nearly 16 million health insurance consumers will get rebates totaling an estimated $1.3 billion beginning Aug. 1 because Obamacare limits the profits that insurance companies can make off of illness, injury and pain.

Take that, Ernestine!

Under Obamacare, more formally known as the Affordable Care Act, insurers must send refunds to customers if the companies skim off excessive portions of premium payments for administrative costs and profits. For big group plans, the law says insurers must spend 85 percent of premiums on patient care. For smaller group plans and individual coverage, it is 80 percent.

This rule took effect in 2011, so insurance companies that spent too little last year on patient care must send rebates to customers this year. One New Jersey company reported it already has returned $19 million to customers.

Here is how the numbers break down, according to calculations by the Henry J. Kaiser Family Foundation, a private, non-profit, non-partisan organization that provides facts and analysis on health care issues.



  • Thirty-one percent of Americans who buy individual health insurance plans will get refunds or discounts on future bills. That's 3.4 million customers. Each will receive an average of $127. The insurance companies - 215 of them - must pay a total of $426 million.

  •  
  • Nineteen percent of workers covered by large group plans will benefit. That's 7.5 million customers. They'll receive an average benefit of $72. (The money will be sent to the employers that pay the premiums and is expected to be shared with the workers who bear part of the cost.) The insurance companies - 125 of them - must pay a total of $541 million.

  •  
  • Twenty-eight percent of workers covered by small group plans will benefit. That's 4.9 million customers. They'll receive an average benefit of $76. (This money also will be sent to employers.) The insurance companies - 146 of them - must pay a total of $377 million.



That's a lot of customers getting a lot of money, Ernestine. And it's not even everything. It doesn't include California, for which Kaiser did not have statistics. And it doesn't include the value of premium hikes Obamacare prevented.

The Kaiser report noted that it's impossible to calculate the entire savings consumers realize as a result of the Obamacare rebate mandate because many insurers kept premiums low to avoid paying refunds. The report explains:

"This 'sentinel' effect on premiums has likely produced more savings for consumers and employers than the rebates themselves."

It wouldn't be happening without Obamacare.

For decades health insurance consumers fumed. Each year, insurance companies jacked up premiums while providing even more arrogant and brutish service. Each year, regional monopolies increased.

Consumers watched helplessly as insurers rescinded coverage from neighbors after tests determined cancer, as insurers declared spina bifida a pre-existing condition in order to deny coverage to newborns, as insured relatives went bankrupt because of co-pays and uncovered costs.

Like Ernestine, insurers snorted at unhappy customers -- because the companies knew customers had no recourse.

But then, Obamacare gave consumers just a little measure of power in their relationship with insurance companies. The law forbids insurers from dropping customers who get sick. It forbids insurers from refusing to cover children because of pre-existing conditions. And it requires insurers to spend a large percent of premiums on actual medical services instead of bloated CEO pay and profits.

This is what Republicans in Congress and in state capitals across the country are trying to take away from health insurance consumers -- that leverage Obamacare gave customers to deal with massive, faceless, bureaucratic insurance companies.

Republicans have asked the U.S. Supreme Court to declare Obamacare unconstitutional. They want to return to the days when insurers could mistreat customers like Ernestine did. They want to go back to the time when customers couldn't do a thing about it.

The U.S. Supreme Court is deciding right now whether insurers are not subject to city, state or federal regulations, whether they are, as Ernestine said, "omnipotent."

 

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In a famous Laugh In sketch, Lily Tomlin, playing arrogant operator Ernestine, telephones a customer to demand payment of $23.64 for three calls to Topeka and threatens to send a burly serviceman to ...
In a famous Laugh In sketch, Lily Tomlin, playing arrogant operator Ernestine, telephones a customer to demand payment of $23.64 for three calls to Topeka and threatens to send a burly serviceman to ...
 
 
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02:45 PM on 06/13/2012
Let's break down the numbers further Mr. Gerard. Based on the data above if we take our total population into account and subtract out those who are assumed to be uninsured we have roughly 264 million people in the US who are insured. Based on the rebates we will see 6% of our insured population get an average amount back of $7.09 per week ($85.06 yr). With premium increases averaging 5% (very unlikely) this rebate becomes worthless. By the way, if an insurance company increases rates by 5% and pays out a rebate of less than 1% aren't we paying more? Not to mention next year with the premium increase the amount of MLR that can be kept by an insurer INCREASES! This is a win win for insurance companies, not those of us who purchase insurance.
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Craig Casey
Nobamacare! Entitlements & taxes must be cut.
05:39 AM on 06/13/2012
MLRs r such a joke, rebates average $43? Wow thanks. Premiums are up over $1000 thanks 2 2 years of #Obamacare. Can't democrats count?
01:59 AM on 05/16/2012
Insurence company can only have 20% profit.And the people how don't have insurence are paid by the people that pay medical bill so you pay for it like it or not
02:31 PM on 06/13/2012
20% is not profit. This figure includes all administrative services. Do you have any clue what the actual average profit margin for a health insurer is?
01:46 AM on 05/16/2012
How can Obamacare be wrong
08:20 PM on 05/07/2012
What a gimmick. Insurance companies love Obamacare. Don't believe me? Look at their stock prices. Humana has risen 300% since Obama took office. The S&P 500 rose 75%. Health insurance companies have been consistently outperforming other sectors since Obama has taken office and it's all thanks to Obamacare. They would probably otherwise be underperforming thanks to high unemployment. This whole "pain and suffering" rebate is a political ploy.
09:01 PM on 05/07/2012
In reply terroh8er......Insurance companies have been increasing their premiums in leaps and bounds long BEFORE President Obama came into the picture. When you take away regulations and safeguards as was done in prior administrations that is what happens. Higher premiums and less coverage is, in truth, what the wonderful insurance companies have been giving customers! I know because I have seen it happen.
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HUFFPOST SUPER USER
A level Head
Consumption not investment requires subsidy
07:52 AM on 05/08/2012
"When you take away regulations and safeguards as was done in prior administrations"

Never happened .... Insurance is not regulated at the Federal Level .. It is regulated at the State Level.

In matter of fact that is one of the bones of contention in the case before the Court
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HUFFPOST BLOGGER
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USW Blogger
07:29 AM on 05/08/2012
Sounds like Terroh8er is all for returning to pre-ObamaCare days -- the days when insurance companies could drop people when they got sick, impose lifetime limits and refuse to cover newborns for "pre-existing conditions."
Maybe Terroh8er actually works for one of those big insurance monopolies!
05:09 PM on 05/08/2012
If I did, I would only have nice things to say about it.
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HUFFPOST SUPER USER
A level Head
Consumption not investment requires subsidy
07:01 PM on 05/07/2012
Thirty-one percent of Americans who buy individual health insurance plans will get refunds or discounts on future bills .....Each will receive an average of $127.

THAT IS 127.00 off an average bill in the 9000 dollar range -- (about 1.25%)

The other two groups mentioned (those covered by GROUP HEALTH INSURANCE) will likely gt an even smaller percentage -- Quite often ZERO.

The money goes to the sponsor (employer) and it belongs to them not the individual. They can at THEIR OPTION pass some, all, or none to the employee.
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HUFFPOST BLOGGER
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USW Blogger
07:27 AM on 05/08/2012
And your point is? I would rather have the $127 in my pocket than zip!
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HUFFPOST SUPER USER
A level Head
Consumption not investment requires subsidy
07:49 AM on 05/08/2012
Reread ... My point is ... Very few people will see any money.

Here is a second point .... The COST of the soon to be flamed statute has already doubled (and it is not yet fully implemented) ... The new Budget Office cost estimates indicate an increase that surpasses the savings.

Third point .... If implemented 100's of employers will drop there plan ... Far better to pay a "penalty" of 2000 than a premium of 10000 dollars.

Then what ??? How far will 127 go. A Dr. visit ???
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flyovermark
...Obamacare is tyranny...
11:46 AM on 05/08/2012
Are you willing to drop your less expensive group plan, and purchase a much more expensive individual plan, to get $127 in your pocket?

If so, I'm betting that every used car salesman in your town already knows your name.
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HUFFPOST SUPER USER
A level Head
Consumption not investment requires subsidy
06:54 PM on 05/07/2012
It amazes me how little people really understand ...

The vast majority of this "refund" goes to sponsors of group plans NOT individual people.

Corps have complete discretion on how they "spend" the money.

One Corporate group (Insurance) is simply passing a rebate to another Corporate group
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HUFFPOST BLOGGER
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USW Blogger
10:08 AM on 05/08/2012
Again, $127 in my pocket is better than nothing. In addition, $127 in the pocket of my employer, who will, in fact, use it to help pay for next year's insurance bills, is better than zip.
So, "level head," you would just do nothing? Just let the insurers run a muck?
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HUFFPOST SUPER USER
A level Head
Consumption not investment requires subsidy
11:33 AM on 05/08/2012
No. I would recognize that insurance is simply a checkbook ... I would recognize that the cost of care is where the cost is located ... I would recognize that fallacy of spending 1000's to save 100's .... I would recognize that most likely my employer benefit will disappear shortly and those 1000's will come from my tax dollar. I would recognize when I have been had. I do, how about you.
05:31 PM on 05/07/2012
My boyfriend had to have 2 hernia operations because the dr screwed up paid $4000for each he is a boomer so he pays more. Big deal $125 back. Wow millions Is too much to earn doing nothing.
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HUFFPOST BLOGGER
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USW Blogger
10:10 AM on 05/08/2012
This comment does not make any sense. If the doctor made an error, sue him. You still have that right, even though the GOP is trying to take it from you.
And the "Wow millions is too much to earn doing nothing" must be a stray comment from another post because it doesn't make sense here.
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SantaMonican
Visit the carousel, in the Hippodrome, on the pier
02:52 PM on 05/07/2012
Republicans have never met a consumer protection that they've liked, ever.

The GOP are all about Insurance Industry protections, patients be d@mned.
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flyovermark
...Obamacare is tyranny...
05:39 PM on 05/07/2012
The insurance industry has "patients"?
02:48 PM on 05/07/2012
I was recently inspired and blown away by this woman who started her own non-profit in Philadelphia called Sink or Swim. One by one, she picks people/families who are in dire straights from mounting medical bills and fundraises to help them pay for their basic needs. This humanitarian made a decision to do SOMETHING, and is making a huge difference just by starting small scale. The Phillies are actually partnering with her organization to help fundraise, and they have a chance to throw the first pitch at the 7/6/12 Phillies game. If you're interested, you can help this incredible woman continue to make a difference by going to www.phillies.com/sosphilly.
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Craig Casey
Nobamacare! Entitlements & taxes must be cut.
05:45 AM on 06/13/2012
Too bad #Obamacare replaces Charity and forms it's own co-op that has already "misplaced" $3.1 billion!!! She'll never run out of family members needing care under Obama's version of "reform"
02:41 PM on 05/07/2012
Left-wing biased opinion; not news!
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Amminadab
None of this is real
03:32 PM on 05/07/2012
I suspect that you wouldn't know "news" if it hit you in the face.
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HUFFPOST BLOGGER
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USW Blogger
10:13 AM on 05/08/2012
There's no attempt to be news here. A blog on Huffington is an opinion piece, NOT NEWS.
HUFFPOST SUPER USER
citycountryboy
02:19 PM on 05/07/2012
A lot of money, and it's across the board, with no consideration given to economic status. YEA!!!
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HUFFPOST SUPER USER
A level Head
Consumption not investment requires subsidy
06:50 PM on 05/07/2012
You do realize of course that the lions share goes to Corps not subscribers -- Actually in the case of employer sponsored coverage it ALL goes to the employer who may or may not choose to pass the dollars in part of full.
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flyovermark
...Obamacare is tyranny...
01:43 PM on 05/07/2012
Translation: "Nice little refund you've got going there America,

...it'd be a shame if something were to happen to it..."
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Amminadab
None of this is real
03:33 PM on 05/07/2012
Yup, Obama is an electioneering genius.

Must really chaff your hide, huh?
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flyovermark
...Obamacare is tyranny...
06:12 PM on 05/07/2012
Did you hear the electioneering genius talking up his wildly popular signature accomplishment in his campaign kick-off speech? Didn't think so.

...only an electioneering idiot would have done that... (snicker)
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KarmaPatrol
Riverboat Gambler, satellite whisperer. Independe
04:04 PM on 05/07/2012
Imagine if medical insurance premiums actually went to health care. Hilarious, right?
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flyovermark
...Obamacare is tyranny...
06:06 PM on 05/07/2012
Insurance premiums don't purchase healthcare, KP. They purchase protection from the risk of a large, and unforseen, healthcare expense. If medical insurance premiums actually went to healthcare, then it would be a healthcare "payment pool", and not healthcare "insurance" at all.

Do you have similar fantasies about auto insurance premiums actually going to auto repairs? Or do you understand that an auto insurance premium protects you from having to have enough assets on hand to replace someone else's car "if" you are "at fault" in an accident when you are driving?
01:27 PM on 05/07/2012
Thank you very much, Gerard. The ACA actually puts money into people's pockets - and helps boost the economy. Although we'd really save more money if we let everyone enroll into Medicare, so-called Obama care, which was patterned after a proposal by the Heritage Foundation, is an improvement over what we had before.

If Romney or the SCOTUS dismantles Obama-care, our whole health care system will collapse. This artcle is another good reason to re-elect Obama. It's also a reason to elect a Congress that will actually provide a real improvement, Medicare for all.

P.s. Name one Republican Congressman who has forfeited his or her government-financed health care. The GOP is all for "socialized" medicine - as long as they get it. Socialized medicine for me, Free market for you. That's the GOP's vision of health care.
HUFFPOST COMMUNITY MODERATOR
gladys46
Know Your Interests, Vote
02:30 PM on 05/07/2012
Allow me to name one Scott Brown (R) MASS who has reportedly placed his 23 yr. old daughter on his government administered healtcare plan ... is that availing oneself of good governance or just plain GOP hypocrisy???
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HUFFPOST SUPER USER
A level Head
Consumption not investment requires subsidy
11:44 AM on 05/08/2012
I believe he WORKS for the Government ... He is therefore on an employer paid plan just like any other employee who has health insurance provided as part of compensation.

It has nothing to do with governance
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Craig Casey
Nobamacare! Entitlements & taxes must be cut.
05:48 AM on 06/13/2012
ACA actually puts money into people's pockets - and helps boost the economy.

So using your logic, we will see a huge bump when people are getting their enormous $127 checks? I'll remember that! then again, the government wants you to think the recession ended 3 years ago!
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HUFFPOST SUPER USER
Jim Tyson
Dyslexic and smart
12:15 PM on 05/07/2012
It is funny how Insurance companies now have a mandatory client base but the prices go up not down and asside from the insurance companies only the DNC makes money off of this.
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HUFFPOST BLOGGER
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USW Blogger
12:56 PM on 05/07/2012
How does the DNC make money???
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HUFFPOST SUPER USER
Jim Tyson
Dyslexic and smart
01:49 PM on 05/07/2012
WHo do you think got the stock options for the Bill that makes it mandatory to get insurance but not manditory for insurance to PAY for the health care NEEDED but what a commity appointed by Obama says it has too. How many of the millions will die while waiting?
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HUFFPOST BLOGGER
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USW Blogger
12:57 PM on 05/07/2012
Also, BTW, insurance companies do not have a mandatory client base because the individual mandate has not yet taken effect.