[jackconsidine]

I was under the impression (from being on the public market and later self-employed, company subsidized insurance which is altogether cheaper and better) that companies have pooling power which allows them to cut deals with insurers. Is that not the case?

[candiddevmike]

There are two kinds of costs with health insurance for companies. The funding to pay claims and the administration of said funding to pay claims. The administration part is the money maker, and while ACA attempted to curtail what they can charge for this/profit from it, they do creative things like "outsource" IT or HR to a separate company (with the executives as ovepaid board members). It's kind of like tax evasion only instead of taxes it's reducing your premiums.

[lotsofpulp]

> they do creative things like "outsource" IT or HR to a separate company (with the executives as ovepaid board members)

Source?

I am seeing 10-K reports showing UHC, Anthem, CVS, Cigna, Humana, Molina, Centene, etc all with profit margins ~5% or less.

Is the claim that executives at one or more of these companies is attempting to bypass ACA regulations (and violating fiduciary duties to their own employer) by overpaying for services to outside entities that the aforementioned executives control?

Seems like a grand conspiracy theory.

[candiddevmike]

It's real. You won't see this on the 10-K, you need to look at the 990s (which tend to be hard to find). Here's Blue Cross Blue Shield Association from 2017: https://projects.propublica.org/nonprofits/organizations/135..., under part 7, independent contractors, you see "HEALTH INTELLIGENCE CO LLC". This is Blue Health Intelligence (as in Blue Cross Blue Shield Intelligence): https://bluehealthintelligence.com/. Their board is made up of a bunch of blue cross execs.

They spent 20+ million with this company, how much do you think the execs on the board get paid? No one knows because they're private/for profit and don't have to publish annoying things like a 990.

[lotsofpulp]

BCBS does not sell health insurance though. The companies I listed are health insurance companies, which would be subject to the ACA.

[chevman]

Check out the VC arms of all these insurers. Lot of capital they got! :)

[tyingq]

Many large companies also self-insure to pay claims, and only pay the insurance company to administrate the plan. That makes the effective cost much lower (well, in relative terms anyway...health insurance in the US is broken.)