UnitedHealth's Big Announcement: Just What the Doctor Ordered?

Money bagsThank you, UnitedHealth Group. Your jaw-dropping profit announcement may be just what the doctor ordered.

ORLANDO--If you are hopeful that the consumer protections in the health care reform law actually wind up benefiting consumers more than the insurance industry, please send a thank-you note to executives at UnitedHealth Group, the largest U.S. health insurer.

United announced Tuesday morning that it's third-quarter profit jumped 23% -- much more than investors and analysts had expected -- largely because it spent far less of its customers' premiums on medical care than it did this time last year. When an insurance company spends less of every premium dollar it takes in on medical care, it has more left over to reward shareholders and a handful of senior managers who already are among the highest-paid executives on the planet.

United's announcement is cause for joy because maybe, just maybe, the nation's state insurance commissioners -- whom Congress gave the responsibility of determining how major parts of the new law will be implemented -- will finally realize that they don't need to give the big insurers the truck-sized loopholes they have been lobbying so hard for over the past several weeks.

It could turn out that UnitedHealth will help consumers the same way the nation's second largest insurer, WellPoint, did several months ago when it announced that it was hiking premiums as much as 37% for many of its customers in California. The news coverage of that proposed increase so outraged members of Congress that they mustered the gumption to finally pass a reform bill that, until then, seemed to be on life support.

I am writing this between meetings at the fall conference of the National Association of Insurance Commissioners (NAIC) here in Orlando. I am one of 28 people selected by the NAIC to represent the interests of consumers. The insurance industry and other special interests are represented here by more than a thousand lobbyists. Like us, they are pacing the hallways waiting to pounce on the commissioners when they emerge from their "regulator-to-regulator" meetings that are closed to the public and the media. It is at these closed-door meetings that some of the most important discussions are taking place, and decisions are being made.

One of the most consumer-friendly provisions of the reform law requires that, beginning next year, insurers will have to spend at least 80 percent of the revenues they receive in premiums from individual and small group customers on medical claims and activities that improve the quality of care. For their large group customers, they will have to spend at least 85%. Insurers that don't meet those minimums will have to give rebates to their policyholders. Congress gave the NAIC the responsibility of writing regulations to implement this provision. Among other things, the NAIC has to determine which insurance company functions qualify as activities that improve the quality of care. We consumer representatives argue that the list of such activities should be short, and should include only those for which there is empirical evidence that they actually do improve care. The insurance industry's lobbyists have tried to get the insurance commissioners to let them count just about all of their administrative functions as quality-improvement activities.

At its summer meeting in Seattle two months ago, the NAIC approved preliminary regulations that represented a reasonable compromise between our positions and those of the industry. The big, for-profit insurers -- including United and WellPoint -- were not at all happy, so in the days leading up to this meeting in Orlando, they dispatched teams of lobbyists to state capitols across the country to cajole and threaten commissioners into seeing things their way. As I write in my upcoming book, Deadly Spin, the insurance industry is especially adept at planning and carrying out fear-mongering campaigns. The central message of the lobbyists who were deployed from coast to coast as part of their most recent fear-mongering campaign is that they will stop covering people in states where they don't think they can make the profits Wall Street expects them to make if the new "medical loss ratio" (MLR) rules don't cut them enough slack. (Insurers consider the amount of money they pay out in medical claims to be a loss.) It is the equivalent of a spoiled brat threatening to take his marbles and go home if he doesn't get to play the game by his own rules. The difference, of course, is that we are dealing not with marbles here, but with people's lives.

The All-Important "Medical Loss Ratio"

During my years as a corporate executive at CIGNA, another one of the big for-profit insurers, one of the things I did was to explain to the financial media why the company's MLR went up or down during a specific period of time. There is constant pressure from investors and Wall Street analysts for insurance company executives to take whatever means are necessary to keep pushing the MLR lower and lower. If they don't succeed, they get punished, often severely, in the stock market. Aetna's stock price once fell more than 20% in a single day after executives disclosed that the company had spent slightly more on medical claims during the most recent quarter than in a previous period. What triggered the "sell" alarm was the company's announcement that its first quarter MLR increased to 79.4% from 77.9% the previous year.

Insurance company executives will never forget the beating that Aetna took that day. Not only did the company's market cap shrink, but so did the stock options held by Aetna's senior executives. The CEO alone lost millions in compensation by reporting an MLR that didn't meet Wall Street's expectations.

Insurance Companies Want to Keep the Champagne Corks Popping

That lesson certainly was not lost on United's executives. One of the main reasons why the company was able to exceed Wall Street's profit expectations for the third quarter that just ended was its ability to push its commercial-segment MLR, which comprises most of its customers, much lower than usual. It dropped a whopping 3.7 percentage points to 80.9%. United, and the other big for-profits, reported even bigger drops during the second quarter of this year. These are the results that bring out the champagne on Wall Street, when you reduce the amount you spend on medical care and make your customers pay more.

Insurers sent their lobbyists across the country to meet personally with the insurance commissioners (and lobbyists are as thick as thieves here in Orlando) because they want the commissioners to give them the slack they need to continue being able to push their MLRs down to what will be a legal minimum next year. The more they can get the commissioners to write the often obscure but critically important rules in their favor -- even if those rules violate the health care reform statute -- the happier it will make Wall Street. That is what is really going on here. It is as simple as that.

The timing of United's embarrassment of riches, however, is causing great concern on Wall Street. Investors and analysts are keeping up with what is going on in Orlando more than anyone except perhaps insurance company executives. They know that the commissioners are expected to complete their work on the MLR regulations Thursday morning and send their recommendations to the Secretary of Health and Human Services, as the law stipulates. In a report Tuesday morning, Carl McDonald of Citigroup Investment Research wrote that United's impressive numbers "couldn't come at a worse time politically. We’re at a critical time juncture, as the Health and Human Services Secretary will soon provide final minimum MLR guidance and decide how often to grant MLR waivers. United beating its initial earnings guidance this year by over $1.6 billion pre-tax certainly doesn’t help the industry’s cause."

You're right, Carl. It is my pleasure to share your thoughts and the news about United's big increase in earnings, made possible by the big decrease in its MLR, with all the commissioners down here in Orlando. By about noon on Thursday, we'll find out whose side the commissioners are really on: consumers, whose interests by law they are supposed to protect, or insurance company executives and investors, who are far more interested in the value of stock options and earnings per share than they are with the health and well-being of their customers.


Tim, you too sound like a lobbyist, agent, or employee of UHC, or similar. For the sake of disclosure, at least let the CMD staff check into your background. I don't trust the mud YOU'RE throwing in the water.

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The situation is not nearly as simple as Potter would like his readers to believe. For one thing United profits over the past five quarters have ranged from 4.3% to 5.3%; not exactly exorbitant. Much more importantly in my view is that the draft NAIC report on what would be allowed under care imrovement costs excluded things such as wellness programs, 24 hour nurse lines, and other common and popular programs that improve disease management and access to care. Insurance companies like these programs because better behaviors, initial care, and disease management equate to lower claims. Potter's group is fighting tooth and nail to keep everything possible outside of the allowed costs regardless of those program's merit. His myopic confrontation with every insurance company position is a distinct disservice to the consumers he is purportedly serving.

Do the math for yourself! In the last 9 months, United Health care has generated revenue of $70,125,000,000. That's more than $70 BILLION. Even at an only 4% rate of profit, that would be more than $2.8 BILLION. Still think that this is only a reasonably performing company and not a greedy corporate entity?

Yes, say goodbye to these programs as insurance companies will just move to raising premiums to keep 15-20% ahead of costs and forget about trying to manage costs. If you want to control costs, need to hit the areas that actually increase them. Believe it or not, insurance companies don't increase those. Physicians, pharma, hospitals, clinics, new technolgy, etc. do. Also, Americans want every possibility of care, don't think for a minute that doesn't raise the cost of care. When your ready to make the hard choices about what care is to be provided, then and only then, will you see the cost of care actually decrease as then research in developing a cure that costs $1 billion but only saves 3 lives a year will stop.

Didn't the CEO get over $1 BILLION in total compensation, not too long ago - and weren't all the bonuses, awards dinners, advertising (read: propaganda), lobbyist fees and the like, taken out BEFORE the net profit was calculated? On what page of the draft NAIC report on what would be allowed under care imrovement costs are exclusions such as wellness programs, 24 hour nurse lines, and other common and popular programs that improve disease management and access to care, mentioned? Does it exlude them ALL or does it set limits (as it SHOULD)? If Medicare can operate with 3% overhead, I think ALL the Health Insurance Companies should too! Get rid of all the parasites.

Medicare runs at 3% overhead because of how large the medical costs are (Seniors use 4x to 5x the services of normal commercial business, so the admin percent looks dramatically lower), not because it is so much more efficient. Using the Admin percent is not a good way to measure efficiency. If you looked at real dollars, Medicare is less efficient than the private sector...it's costs for the same functions of private insurers are less efficient. As for all the complainers about insurers making a 2-5% margin on their business, since when is that excessive? Where is your complaining about Pharma which makes on average 20% margins, Medical device makers are near 10-15%, and provider organizations which are substantially higher too. Why be selective only with the insurer with your outrage?

I ask again, weren't all the bonuses, awards dinners, advertising (read: propaganda), lobbyist fees and the like, taken out BEFORE the net profit was calculated? How much does Medicare spend on those (especially compared to your poor, bedraggled insurance companies)? Where are you getting your "facts" and figures from (like "Medicare is less efficient than the private sector")? Are you paid or compensated in some way by any of them to do this? Don't worry your little head, I detest PHRMA and the device manufacturers as much as the health insurance industry, but this isn't about THEM, is it? Should the common health of American citizens be profit driven? Should only the affluent have health care/insurance?

You guys pushed on this web site for a long time for health care, and now that health insurance will be mandatory in the next few years, many have gone ahead and bought insurance policies. Now you're mad the law you pushed requiring people buy health insurance resulted in a profit for the insurance companies. What exactly did you expect to happen? Health Insurance companies to give out free lollipops in ticker-tape parades declaring the end to poor health choices?

The same day as United Health's announcement of their $1.3 billion quarterly profit, they announced that they are launching a new cancer treatment reimbursement program which will outline treatment regimes and pay only a lump sum for the course of treatment. Outrageous! I am a 12-year cancer survivor and cannot fathom how an insurance company gets the power to determine - and limit - my treatment regime. I'm so angry about the greed that is rampant at that company! For the full story, view the Minneapolis Star Tribune article on Oct. 20.