• Menu
  • Skip to primary navigation
  • Skip to main content
  • Skip to primary sidebar

Before Header

  • About Us
  • Lexicon
  • Contact Us
  • Our Store
  • ↑
  • ↓
  • ←
  • →

Balloon Juice

Come for the politics, stay for the snark.

This is how realignments happen…

Since when do we limit our critiques to things we could do better ourselves?

I’d try pessimism, but it probably wouldn’t work.

The cruelty is the point; the law be damned.

No offense, but this thread hasn’t been about you for quite a while.

False Scribes! False Scribes!

It’s always darkest before the other shoe drops.

They fucked up the fucking up of the fuckup!

Saul Alinsky is my co-pilot.

You are either for trump or for democracy. Pick one.

‘Forty-two’ said Deep Thought, with infinite majesty and calm.

Deploy the moving finger of emphasisity!

We need fewer warriors in public service and more gardeners.

People are complicated. Love is not.

Tick tock motherfuckers! Tick fucking tock!

If you tweet it in all caps, that makes it true!

No one could have predicted…

Naturally gregarious and alpha

This blog will pay for itself.

We still have time to mess this up!

Well, except the wingnuts. fuck those guys!

I really should read my own blog.

Not all heroes wear capes.

Peak wingnut was a lie.

Mobile Menu

  • Look Forward & Back
  • Balloon Juice 2021 Pet Calendar
  • Site Feedback
  • All 2020 Fundraising
  • I Voted!
  • Take Action: Things We Can Do
  • Team Claire, and Family
  • Submit Photos to On the Road
  • BJ PayPal Donations
  • Politics
  • On The Road
  • Open Threads
  • Topics
  • Nature & Respite
  • Information As Power
  • COVID-19 Coronavirus
  • Authors
  • About Us
  • Contact Us
  • Lexicon
  • Our Store
  • Politics
  • Open Threads
  • Garden Chats
  • On The Road
  • Nature & Respite
  • Look Forward & Back
You are here: Home / Anderson On Health Insurance / CSR, MLR and a surplus of cynicism

CSR, MLR and a surplus of cynicism

by David Anderson|  October 4, 20177:12 am| 5 Comments

This post is in: Anderson On Health Insurance

Facebook0Tweet0Email0

The following is a speculative post that is entirely cynical.

Cost Sharing Reduction (CSR) may or may not be paid in 2018. Some insurers in some states are loading all of the projected costs of CSR into their baseline premium rates. There is a chance that CSR will be paid in 2018 in full and in a timely manner. If CSR is paid in full and in a timely manner because they are either appropriated or the Court of Appeals reversed the district court ruling or the Administration continues to pay CSR for some reason, premiums will not change in 2018.

Insurers in the scenario where CSR is paid in full will effectively be double-dipping in a legal manner. They will be getting CSR money from the federal government and CSR money from the increased premium levels. Assuming that the actuaries are vaguely competent, the insurer in this scenario should be rolling in cash.

They should be rolling in enough cash where they are not in compliance with the Medical Loss Ratio requirement. An individual market company needs to spend 80% of their premium dollars on claims. If they don’t do that on a three-year rolling basis, they have to write checks that make up the difference back to their policyholders. Those checks are treated as tax-free rebates from previous purchases.

The rebates are sent in the following September after the end of the policy year.

In this scenario, in the fall of 2019, rebate checks start showing up just as final rates are to be approved. If there is still CSR uncertainty, rate regulators will have strong incentives of getting great press on being tough on the insurance companies by forcing them to hand out very large checks to tens of thousands of residents. They will have a strong incentive to continue to approve Silver load rates especially if they can get lower rates on the non-subsidized market by going full Silver Switcheroo by requiring insurers to offer Off-Exchange only Silver plans in addition to the on-Exchange Silver plans.

And then in the fall of 2020, ambitious state insurance commissioners will be handing out rebate checks in late September as they are running for Governor or the Senate. Or if they are a bit less ambitious, they are supporting the incumbent party by handing out checks and injecting new federal money into the state and making the fundamental background economic picture a bit better than it otherwise would have been.

I might be getting too cynical today.

Facebook0Tweet0Email0
Previous Post: « On the Road and In Your Backyard
Next Post: Plumbing Medicare for All transitions »

Reader Interactions

5Comments

  1. 1.

    satby

    October 4, 2017 at 7:39 am

    I don’t think it’s possible to be too cynical with the current crop of jerks in power, but I think that thinking as far ahead as this scheme you’ve outlined requires exceeds their abilities.

  2. 2.

    Mary G

    October 4, 2017 at 8:34 am

    I was wondering if that might happen. I imagine all the lobbyists for the insurance companies are pressing even harder for CSRs to be paid so they can collect twice and having their accountants figure out how to cook the books to make sure they keep as much of it as they can.

  3. 3.

    Tom Levenson

    October 4, 2017 at 10:18 am

    There is no amount of cynicism that could possibly form a surplus. Not while Donald Trump sits in the Oval, Ryan in the Speaker’s chair, and the turtle holds sway (of a sort) in the other chamber.

  4. 4.

    Neldob

    October 4, 2017 at 3:35 pm

    Blessings all around you for swimming in the shark tank. So the rest of us don’t have to.

  5. 5.

    Ragbatz

    October 4, 2017 at 4:43 pm

    Come to think of it, who needs CSR uncertainty to pull off this trick. Routinely approve premiums excessive to the point of fraudulence, and blame “Obamacare”; then take credit for clawing back excess profits. So, in Georgia for example, the state has reportedly approved two premium tiers – one assuming no CSR assurance and one if CSR becomes assured. Yet, even the CSR-assured rates have huge increases for 2018 over 2017.

    Query: has anyone tried to challenge, judicially, state ratemaking based on MLR noncompliance? Do the retroactive clawback provisions of the ACA impliedly preempt such challenges?

Comments are closed.

Primary Sidebar

Do Something!

Call Your Senators & Representatives
Directory of US Senators
Directory of US Representatives

Vaccine Venting (latest)
Vaccine Venting (all)

I Got the Shot (latest thread)
I Got the Shot! (all)

Take Your Shot – Explain the %

🎈Ways to Support Our Site

Become a Balloon Juice Patreon
Donate with Venmo, Zelle or PayPal
Shop Amazon via this link to support Balloon Juice ⬇  

Recent Comments

  • different-church-lady on J&J Pause (Apr 13, 2021 @ 12:50pm)
  • Baud on J&J Pause (Apr 13, 2021 @ 12:50pm)
  • different-church-lady on J&J Pause (Apr 13, 2021 @ 12:50pm)
  • Baud on Press Briefing: Jen Psaki and Dr. Fauci (Apr 13, 2021 @ 12:48pm)
  • burnspbesq on J&J Pause (Apr 13, 2021 @ 12:48pm)

Team Claire, and Family

Claire Updates
Claire is Home!

Balloon Juice Posts

View by Topic
View by Author
View by Month & Year

Featuring

John Cole
Silverman on Security
COVID-19 Coronavirus
Medium Cool with BGinCHI
Furry Friends

Calling All Jackals

Site Feedback
Submit Photos to On the Road
Nominate a Rotating Tag
Meetups: Proof of Life
2021 Pets of Balloon Juice Calendar

Culture: Books, Film, TV, Music, Games, Podcasts

Noir: Favorites in Film, Books, TV
Book Recommendations & Indy Recs
Mystery Recommendations
Netflix Favorites
Amazon Prime Favorites
Netflix Suggestions in July
Longmire & Netflix Suggestions

Twitter

John Cole’s Twitter

[custom-twitter-feeds]

Site Footer

Come for the politics, stay for the snark.

  • Facebook
  • RSS
  • Twitter
  • Comment Policy
  • Our Authors
  • Blogroll
  • Our Artists
  • Privacy Policy

Copyright © 2021 Dev Balloon Juice · All Rights Reserved · Powered by BizBudding Inc

Share this ArticleLike this article? Email it to a friend!

Email sent!