News Release

Top Insurers Divert 1 in 4 Premium Dollars Away from Patient Care

For Immediate Release

An investigation of six of America’s largest health insurers concluded that over one quarter of policy-holders’ premiums on the individual health insurance market did not go to medical care in 2009, according to a Senate Commerce, Science, and Transportation Committee report released yesterday.

“Insurers were spending millions to fight health reform in Washington, while at the same time they were shorting patient care for consumers across the country,” explained Larry McNeely, the Health Care Advocate for consumer watchdog, Texas Public Interest Research Group.

Federal regulations, called for in the recent health reform law, will require that 80% of premium dollars go to care, starting in 2011. Insurers who do not meet the new standards will have to rebate the difference to their customers. But the report warns regulators to be vigilant for insurers’ attempts to evade the forthcoming regulation.

According to the Implementing Health Insurance Reform report, insurers resisted providing this information, and investigators had to ultimately obtain data from the National Association of Insurance Commissioners. The following chart details the percentage of premium revenue which the top six insurers actually spent on claims in 2008 and 2009 in the individual, small group, and large group health insurance markets, according to the report.

 

Individual

Small Group

Large Group

Aetna

75.70%

84.20%

87.20%

Cigna

88.10%

92.10%

85.20%

Coventry

71.90%

78.20%

86%

Humana

68.10%

80%

88.20%

United Health

70.50%

81.10%

83.30%

Wellpoint

74.90%

81.20%

84.90%

Total

73.6%

81.2%

85.1%

The Committee also published the amount each insurer received in premiums and the amount paid out for actual medical claims. The difference, the amount not spent on care by these six companies, amounts to $2.15 billion in the individual market, $5.7 billion in the small group market, and $6.6 billion in the large group market.

“It’s appalling,” McNeely said. “Insurers have been fleecing Americans out of billions of dollars. Thankfully, the new health care reform law will soon require insurers who don’t provide a good value to rebate that money back to their customers.”

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