Healthcare Reform Costs to Insurers May Exceed Forecasts

Janice Simmons, for HealthLeaders Media , August 13, 2010

To view the impact of the reform on the industry's earnings, the Weiss study reviewed 543 health insurers--distinguishing between two groups: 226 not yet compliant companies, or those that spent less than 85% of their premiums on medical expenses in 2009; and 317 "already compliant" companies, or those that already spent 85% or more of their premiums on medical expenses in 2009.

Weiss found that "already compliant" companies including income from both their insurance underwriting operations and from their investments earned a total of $1.74 billion—or an average of $5.5 million each. In contrast, the "not yet compliant" companies earned far more—7.68 billion, or an average of $34 million each.

With underwriting income, the difference between premiums collected and medical claims paid showed sharp differences. Thus as a group, the "already compliant" companies lost $372 million on their insurance operations, with an average underwriting margin of a negative 0.2%; the "not yet compliant" companies earned $6.11 billion with an average underwriting margin of 5%.

The overall size of the insurer was also a factor since larger companies tended to have more investment income--making it possible for them to anticipate higher medical expenses per premium dollar. However, the contrast between the two groups remained great even without the size differences, according to the report.

Janice Simmons is a senior editor and Washington, DC, correspondent for HealthLeaders Media Online. She can be reached at

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