Health care insurers such as Indianapolis-based WellPoint Inc. get some big presents in the Senate’s health overhaul bill
— about 20 million new customers and no competition from a new government plan.
Taking advantage of those boons might
take some time, though.
The bill imposes hefty new taxes and coverage rules that will pinch insurers by forcing them
to cover more sick people without gaining enough healthy, lower-cost customers, industry insiders say. The industry is also
worried the bill doesn’t do enough to control health care costs.
It’s a matter of figuring out how to make those new
customers profitable, analysts say.
"There’s opportunity," Miller Tabak analyst Les Funtleyder said. "Where
the rubber meets the road is can you access that opportunity? At least some of them will figure out how to do it."
Senate bill is much more favorable to insurers than a similar bill passed in the House that contains a government-run option
for consumers seeking individual insurance, something insurers have fought hard. They worry that a government-run plan that
sets rates below market prices would pose unfair competition.
Though the Senate bill still has to be reconciled with
the House bill, most observers believe the government-run plan, often called a "public option," will disappear because
it lacks Senate support.
Both bills call for the creation of insurance exchanges that help people buy coverage. Insurers
likely will lose money on business from those exchanges, said Robert Laszewski, a former insurance executive and president
of Health Policy and Strategy Associates, a Virginia-based health care consultant.
It’s a tradeoff: People without insurance
would be required to buy it — in some cases, subsidies will help them pay for it — or face fines if they don’t.
Insurers, in turn, would no longer be able to deny coverage based on pre-existing conditions such as diabetes or cancer.
the proposed fines are too weak and the subsidies too meager to truly motivate people to buy insurance, Laszewski said. This
means the people most motivated to buy coverage through these exchanges will be those who already have health problems —
who are money losers for insurers.
Insurers need a mix of healthy people enrolled in their coverage to help balance
out claims they pay for patients who use more insurance.
The Senate bill calls for fines for people who do not purchase
coverage and are not exempt from a mandate to buy it. They start at $95 in 2014 and rise to $750 by 2016.
That’s a lot
more affordable than what some people would pay for insurance. A sliding scale of subsidies will help people or families with
incomes up to 400 percent of the federal poverty level, or $88,200 for a family of four this year. But a family of four with
income of $65,000 would still have to pay nearly 10 percent of that income, or $6,500, toward coverage.
aren’t a lot of families with an extra $6,500 in their checking account," Laszewski said. "The problem with this
bill is the subsidies are really quite modest, and there really aren’t any penalties."
An ideal bill for insurers,
he said, would pair better subsidies for the uninsured with higher penalties that motivate people to buy coverage and get
more healthy people into the risk pools.
The Senate bill hurts managed care companies in other ways. Insurers use a
person’s age and other variables to figure out the price of an individual insurance policy. Older people often have to pay
more because they tend to generate more claims. But the Senate bill limits how much more insurers can charge for older customers.
means people under age 30 likely will see a "substantial increase" in the cost of a policy — making them less
inclined to buy insurance — while older people will see a smaller decrease, said Brad Fluegel, chief strategy and external
affairs officer for WellPoint, the nation’s largest health insurer based on membership.
The Senate bill also calls for
the industry to pay annual fees for the plan that start at $2 billion in 2011 and increase to $10 billion by 2017. Analysts
say costs like these will be passed to consumers because insurers want to protect profit margins, which are generally thinner
than other health care companies like drugmakers.
"I think we’re going to be discussing health care reform continuously
for the next several years as we try to fix all the things that are broken with this existing bill," Fluegel said.
up, insurers say the bill would mean higher premiums for consumers and likely for employers who buy coverage. And that’s on
top of hikes spurred by rising medical care.
The stock market no longer seems worried. Shares of the five largest managed
care companies have risen more than 120 percent, on average, since they bottomed out in early March. In contrast, the Standard
& Poor’s 500 index has increased about 63 percent over the same span.
Investors had big worries when the debate
picked up steam last spring, but stocks started climbing as they realized "doomsday scenarios" such as a government
takeover would not happen, Funtleyder said.
He thinks insurers will learn to live with the overhaul and eventually benefit
from it. They should be able to adjust their prices to accommodate taxes, fees and the new regulations once they understand
the claims their exchange customers will generate.
"It’s kind of tricky, at least in the beginning."