Insurance Companies made a fortune during a pandemic
by Wendell Potter - Tarbell - January 28, 2021
As millions of Americans celebrated President Biden’s inauguration, some of my former colleagues in the health insurance industry were quietly celebrating some news of their own: their most profitable year ever.
That’s right: insurance companies made a fortune during a pandemic.
Just hours before President Biden took the oath of office, UnitedHealthcare quietly released the news that it had blown away Wall Street's most optimistic profit expectations for 2020, the year of the worst public health crisis in our lifetime that’s seen more than 400,000 Americans die.
The company reported that although it insured fewer people in the United States in 2020 than in 2019, it took in $15 billion more in revenues. One of the ways it was able to pull that off? By paying far fewer claims last year than the year before. Again, this was during a pandemic.
Had it not been for membership gains in its Medicare Advantage and Medicaid plans, UnitedHealth would've hemorrhaged even more health plan enrollees. In fact, it covered 1.5 million fewer in individual and employer-sponsored/group plans than in 2019 but made BILLIONS more in profits.
One reason for the drop in health plan enrollment: millions lost health insurance with their jobs during COVID-19. That isn't a problem for Big Insurance. I hope President Biden pays close attention to how UnitedHealth and others have made huge profits since the Affordable Care Act was passed.
Mr. President, you called it a “big f*cking deal” when President Obama signed the ACA into law. It brought insurance to 20 million of the 50 million Americans uninsured at the time and made it illegal for insurers to deny coverage to people with preexisting conditions. But ...
Insurance lobbyists rigged the bill in ways that guaranteed huge profits for years to come. Consider this: when you were sworn in as Vice President in 2009 you could’ve bought a share of UnitedHealth stock for $21.55. When you became president yesterday, that share would cost $350.84.
No wonder Wall Street loves UnitedHealth and other big health insurers so much. UnitedHealth's shares alone have increased 1,650% over the past 12 years. How much have American wages increased in that time? Not much. How much have their premiums increased? A lot.
Meanwhile, tens of millions are still uninsured. Even more are "underinsured" because of absurdly high deductibles insurers charge us before they’ll pay a dime. That's why so many of us with insurance go bankrupt or turn to GoFundMe to beg for money to pay medical bills.
Get this: United Health now makes more than two times as much from government programs like Medicare Advantage and Medicaid, than from its "commercial" customers. Most of its revenue by far is coming from taxpayers, rather than their corporate & individual customers.
Mr. President, to help people get the care their doctors say they need, investigate this industry and take action to put an end to this outrageous profiteering. We taxpayers are being taken to the cleaners by these companies. I know because I worked for them. Let’s talk.
For-Profit Health Insurnace Corporations are Funding Insurrectionists
by Wendell Potter - Tarbell - January 13, 2021
There’s been a lot of talk this week about big corporations such as Amazon, Verizon and Comcast deciding to stop giving money to House and Senate Republicans who voted to overturn last year’s election.
Guess which giants aren’t on that list? America’s big for-profit health insurers.
Over the past two election cycles, Big Insurance has donated to just about all the 147 House and Senate Republicans who voted against certifying the election. That includes Cigna and Humana, where I once worked, and Centene and CVS/Aetna. Plus, the industry’s lobbying group, the American Health Insurance Plans (AHIP).
The Blue Cross Blue Shield Association, which represents a lot of nonprofit insurers and for-profit Anthem, says it’s suspending donations to those Republicans. And UnitedHealth says it will “pause” its political donations. But let’s see how long these “pauses” actually last.
So far, we haven’t heard a peep from AHIP or the other big for-profits, all of which have made huge profits during the pandemic, thanks largely to having lawmakers on both sides of the political aisle in their pockets.
Big Insurance donated more than $9 million to House and Senate candidates during the 2020 cycle. Among their favorites? Ted Cruz and Josh Hawley, who led the effort to overturn the election. All the big for-profits donated to Cruz, and all but CVS/Aetna donated to Hawley.
Enough with the games.
It’s time for Centene, Cigna, CVS/Aetna, Humana, UnitedHealth, AHIP and Blue Cross Blue Shield to permanently suspend donations to members of Congress who voted to overturn the wishes of America’s voters to push Donald Trump out of the White House.
It’s also time for all Democrats to refuse donations from Big Insurance from now on. My old industry is also one of the biggest spenders on *lobbying* in Washington, dropping more than $65 million lobbying Congress and the White House, all to protect their profits.
Meanwhile, growing numbers of health insurance customers are forced to file for bankruptcy, or turn to GoFundMe because of denied claims and exorbitant deductibles & copays. Big Insurance is already doing enough damage. The least it can do is stop funding an insurrection.
Letter to the editor: Time for action on universal health coverage in Maine
A nonprofit group started by Maine residents is planning to circulate petitions to put a resolve before voters in November 2022.
Maine Health Care Action, a nonprofit 501(c)4 organization started by Maine residents, plans to collect petition signatures to approve a resolve that will be presented to Maine voters in November 2022. The resolve instructs the Maine Legislature to “develop legislation to establish a system of universal health care coverage in the state and directs the joint standing committee to report out a bill to the Legislature to implement its proposal by 2024.” The resolve is simple and straightforward, reflecting the will of the electorate that our Legislature address the inequities and costs of a dysfunctional delivery system and pass comprehensive health care reform.
The specifics of the legislation will be determined by the Legislature, including funding mechanisms. There will be many opportunities for public comment and input. The time has passed for just establishing “study committees” or referring health care bills to legislative subcommittees never again to see the light of day.
The task before Maine Health Care Action is uphill but surmountable. With limited resources, we will depend on individual financial contributions and volunteers to collect the 63,067 valid signatures for the resolve to appear on a statewide ballot. For further information on our resolve and Maine Health Care Action, go to www.Mainehealthcareaction.org.
Faced with opposition from special interest groups, we anticipate overwhelmingly strong public support for our resolve. It will be up to the Legislature to balance many competing interests and come up with a cost-effective health care system that will benefit all Maine people.
William Clark, M.D.
board member, Maine Health Care Action
Brunswick
Larry Kaplan, M.D.
chair, Maine Health Care Action
Cape Elizabeth
Who Owns Stocks? Explaining the Rise in Inequality During the Pandemic
Bad economies usually hurt both workers and investors. Only the first part has been true this time.
by Robert Gebelloff - NYT - January 28,2021
Bad economies usually hurt both workers and investors. Only the first part has been true this time.
Last year featured a devastating public health crisis, an imploding job market, a heavy dose of political tumult and — surprisingly — a roaring stock market.
Add it all up, and a major consequence was an expansion of inequality in a nation where economic disparity was already on the rise.
It boils down to which groups were hurt most by the sinking parts of the economy and which ones benefited most from the rising share prices.
In the brick-and-mortar part of the economy, lower-wage workers were disproportionately affected by the job losses. At the same time, Americans benefited from gains in share prices: both people who own individual stocks in brokerage accounts and those who own stocks in personal retirement accounts, like mutual fund IRAs, or in those offered by employers, such as 401(k)s.
Yet that’s where even more disparity kicked in, an analysis of data from the Federal Reserve’s 2019 Survey of Consumer Finances shows. Although the distribution of income is unequal in the United States, ownership of financial assets in general and stocks in particular is even more so.
The survey, conducted every three years, collects exhaustively detailed financial information from a sample of American “economic units” — we’ll call them families — including income, the types of assets they own and what those assets are worth.
An analysis of this data shows that in 2019, the top 1 percent of Americans in wealth controlled about 38 percent of the value of financial accounts holding stocks. Widen the focus to include the top 10 percent, and you’ve found 84 percent of all of Wall Street portfolios’ value.
Using the broadest definition of Wall Street involvement, which includes everything from workplace 401(k)s to personal IRAs, mutual funds and pension holdings, just over half of American families have at least one financial account tied to the market, while just one in six report direct ownership of stock shares. Wealthier people are far more likely to have these accounts than middle-class families, who in turn are far more likely to be in the market than working-class or poor families.
And the wealthy, not surprisingly, are more likely to have larger portfolios.
A paper-napkin calculation that assumes all market participants averaged last year’s 16 percent gain in the S&P 500 would mean that American families fattened their portfolios by $4 trillion over all last year. But $3.4 trillion of that would have gone to just 10 percent of families, leaving the other 90 percent to split $600 billion.
Dealbook: An examination of the major business and policy headlines and the power brokers who shape them.
Beyond the gap in holdings between the very rich and the merely affluent, there is also a gap between the affluent and the middle class. Only half of households in the 40th-to-49th percentiles of net worth have any brokerage or retirement accounts that include stocks. But among households in the 80th-to-89th percentiles, 84 percent are invested in at least one holding.
Moreover, the median portfolio size for households in that middle group was $13,000 in 2019, and so would have gained about $2,000 in last year’s market. The typical family in the wealthier group had $170,000 in the market and would have gained about $27,000 with a similar portfolio.
These wealth differences are far starker than the inequality we usually talk about on the income ladder.
Fourteen percent of individual income flowed to the 1 percent of wealthiest American households in 2019, the analysis found. But that 14-to-1 relationship was nothing compared with other categories.
In addition to controlling 38 percent of the value of stock accounts, the top 1 percent control 18 percent of equity in residential real estate, 24 percent of the cash held in liquid bank accounts, and 51 percent of the value of accounts that directly hold individual stocks.
Edward N. Wolff, an economist at N.Y.U., measured the economic disparity on a scale of 0 to 1 (the Gini coefficient). He says the income reported by households in the 2019 survey rates 0.57 on the inequality scale, slightly higher than it was 20 years ago. On the same scale, inequality for net worth rates a 0.87, up from 0.83 in the 2001 survey.
The disparities go beyond wealth groupings. The analysis of the Survey of Consumer Finances showed that Black Americans, who already account for a disproportionately low share of the nation’s income, fare even worse when it comes to assets.
They made up 14 percent of the survey population, but accounted for just 8 percent of 2019 income, 5 percent of the money in liquid assets and 2 percent of Wall Street holdings. Even if you remove from the calculus the top 1 percent — a group that is disproportionately white and controls a hugely disproportionate share of all categories — the African-American share of Wall Street equity rises to just 3 percent.
Among households that rank in the middle class, the disparity is smaller but still there: African-Americans made up 13 percent of that group in the survey, earned 11 percent of income and held 9 percent of Wall Street equities.
It’s not unheard-of for Wall Street to treat gloomy developments as good news. A mass layoff can be seen as both a devastating human event, and a cost-cutting move to boost next quarter’s profits. Generally speaking, though, a bad economy means a bad market — which is why the present situation seems so peculiar.
Last year, a sharp one-month market decline was followed by a steep rebound, even as the job market — and everything else in the world — remained deeply uncertain.
By comparison, share prices tumbled for about two years around the early 2000s recession. In 2008, the S&P 500 went into a 16-month slump at the dawn of that recession.
The disparities in wealth in the United States were already growing heading into the pandemic in 2020. Thirty years ago, the top 5 percent of Americans controlled just over half of the nation’s wealth. By last year, that figure was approaching two-thirds of wealth, and based on how the economy went in 2020, it wouldn’t be surprising if that threshold was breached.
https://www.nytimes.com/2021/01/26/upshot/stocks-pandemic-inequality.html?
Biden’s Obamacare Do-Over: Another Chance to Sign Up, This One More Publicized
Evidence from states that also reopened enrollment suggests it could pull more young, healthy Americans into insurance coverage.
by Sarah Kliff and Margaret Sanger-Katz
In December, the last Obamacare enrollment period under the Trump administration closed. Now that the Biden administration has arrived, it’s trying a do-over.
The renewed effort reflects the Biden team’s view that the Trump administration did too little to help people find coverage, despite a public health crisis and waves of job losses. Although insurance sign-ups were up a bit compared with last year, the growth did not match the increase in need.
In an executive order he signed Thursday, President Biden created a 90-day enrollment period starting Feb. 15 on Healthcare.gov, the insurance marketplace that serves 36 states. The White House plans to run an outreach campaign with paid advertising and direct-to-consumer marketing.
The 14 states that manage their own marketplaces are likely to follow suit, nationalizing the effort. California already announced it would do so Thursday.
“There’s no question that this is a better-late-than-never situation for this open enrollment,” said Eliot Fishman, a senior director for health policy at the consumer group Families USA, who served in the Biden transition but did not work on this policy.
Around 15 million Americans lack insurance and would be eligible for marketplace coverage, according to a recent report from the Kaiser Family Foundation. Four million of them would qualify for a plan without premiums.
“The four million people who could be getting free coverage who are instead uninsured — that, to me, is just screaming out for outreach,” said Cynthia Cox, a vice president at the foundation and a co-author on the report.
Many people advising the Biden administration emphasize that Obamacare will work better as a safety net if more people understand it exists. Unlike self-employed people who have signed up for Obamacare plans for years, many of the Americans losing their insurance now have never used the marketplaces or Medicaid. They may need advertising to tell them about the opportunity, as well as professional help to select a plan.
Ms. Cox said the marketing needs to emphasize not just that sign-ups are possible, but also that people can get financial help buying insurance — and why insurance is worth having. In 2017, the Trump administration cut the program’s advertising budget by 90 percent.
But increasing all the services that help connect people with coverage may take time. Biden administration officials may find themselves hamstrung by the lack of pre-existing networks of outreach workers. State officials say such networks were crucial to getting the word out during their extra sign-up periods.
The Affordable Care Act already allows people who lose jobs or experience a change in income to sign up for coverage outside of the regular fall open enrollment period. What the Biden administration will do is open the marketplaces to all Americans, without requiring them to provide paperwork proving their eligibility.
Evidence from states that tried something similar last spring suggests that the extra enrollment time could be an effective way to bring coverage to hard-to-reach populations: younger Americans, and those who have remained uninsured despite the health law’s coverage expansion.
“It wasn’t a deluge of people, but we were pleased with the type of people we were drawing in,” said Audrey Gasteier, chief of policy and strategy at the Massachusetts Health Connector. It ran a special enrollment period for nearly five months last year, and had 22,800 sign-ups as a result.
Usually, about a quarter of the Connector’s enrollees are between 18 and 34. But that figure was 40 percent for those who signed up during the special enrollment period, suggesting that the pandemic may have nudged so-called Young Invincibles to decide health insurance was worth the cost.
“The value of health insurance skyrocketed for a lot of Americans,” said Michael Marchand, chief marketing officer for the Washington Health Benefit Exchange. “All of a sudden masks, Clorox wipes and health insurance became really important.”
Washington also had a higher than usual rate of younger people among the 7,000 who took advantage of that state’s extra enrollment period last spring.
Health insurers tend to oppose expanding enrollment opportunities: Limiting sign-ups to once a year is seen as an incentive for people to carry coverage all the time instead of waiting until they get sick to sign up, which can increase premiums. But conditions during the pandemic are different enough that the major health insurance lobbies favor a new enrollment period this time.
States that reopened their marketplaces did so with significant outreach campaigns. Washington and Massachusetts used the state agency that manages unemployment benefits to notify the newly jobless that they might qualify for health insurance benefits through the marketplace. California doubled its usual marketing budget last year.
They also tapped navigators and enrollment assisters, who could get the word out that the sign-up period remained open — often doing so over Zoom webinars rather than in-person events.
But the Biden administration has to deal with Trump-era cuts to Obamacare advertising and to in-person outreach. Last year, for example, South Carolina and Utah received no federal funding for the health law’s assistance-focused “navigator” program.
“If you don’t have that infrastructure there to start with, building it will eat up a lot of the time on the clock,” said Kevin Patterson, chief executive of Connect for Health Colorado, the state’s insurance marketplace. “It’s going to be harder.”
Lack of information about Obamacare is not the only reason that millions are uninsured. Millions of poor Americans in the 12 states that have not expanded their Medicaid programs can’t get any financial help buying their own insurance.
Experts from the right and the left also argue that the high cost of health insurance and the deductibles people must pay even after getting covered discourage many middle-class Americans from buying health plans. Improving the affordability of health coverage, however, is hard to accomplish through executive action.
“We’ve got middle-class Americans who want coverage in a pandemic and can’t afford it,” said Peter Lee, the executive director of California’s marketplace, Covered California. Mr. Lee strongly supports federal policy to lower what consumers pay for insurance.
As part of his latest coronavirus relief proposal, Mr. Biden has recommended legislation that would increase the generosity and breadth of tax credits that help people buy their own insurance. But any changes to those subsidies will require action by Congress.
Sarah Kliff is an investigative reporter for The New York Times. Her reporting focuses on the American health care system and how it works for patients.
https://www.nytimes.com/2021/01/28/upshot/biden-obamacare-enrollment.html?
Debt among older Americans increasing in good part because of health care costs
by Diane Archer - JustCare/NYT - JANUARY 26, 2021
More older Americans are facing debt now than 20 years ago, reports the Employee Benefits Research Institute (EBRI). And the size of their debt is twice what it has been. One principal reason: Health care costs.
Medicare only covers about half of a typical person’s health care costs, in large part because it does not pay for long-term supports and services. Expanding and improving Medicare for everyone in the US would help reduce debt significantly for older adults. Not only would it cover health care costs in full, without copays and deductibles, it would cover long-term care. Expanded Social Security benefits would also help tremendously.
The government and businesses once helped to support older people in retirement to a far greater extent than they do today. Medicare covered a larger proportion of people’s health care costs and people did not have to rely as heavily on their Social Security benefits for basic needs as they currently do.
According to EBRI, “American families with heads just reaching retirement or those newly retired are more likely to have debt — and higher levels of debt — than past generations.” The EBRI data show that 68.4 percent of older adults 55 and older faced debt in 2019, up from 53.8 percent in 1992. Fifty-seven percent of older adult heads of household between 65 and 74 carried debt in 2016. In 1998, 47 percent of them carried debt.
The proportion of older adults 75 and older with debt is higher than it has been since 1992. In 2019, 51.4 percent of heads of household who were 75 and older carried debt. In 2007, 31.2 percent of them carried debt.
Total debt for 50 to 64 year olds increased by 50 percent between 1992 and 2016, from $80,000 to $120,000. But, for all people 55 and older, average debt decreased a bit from $88,245 in 2010 to $82,481 in 2019.
Older adults represent about 12 percent of people filing for bankruptcy. That’s five times the percentage of older adults who filed for bankruptcy 25 years ago.
As wealthy people age, their debt tends to fall. As people with less wealth age, their debt tends to grow. And mortgage and credit card debt are most prevalent among people 70 and older.
Blacks and Hispanics and people with low incomes are at severe risk of economic insecurity as they get older. They are more likely than white Americans to spend 40 percent of their income paying off their debt. They are most likely to have credit card debt and loan debt to pay for basic needs.
Older adults also often have student loan debt to pay off. It can be their student loans or their kids’ loans.
https://justcareusa.org/debt-among-older-americans-increasing-health-care-costs/?
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