After Making $2 Billion In Profits, Insurer Complains It Doesn’t Get Enough Government Money

By all appearances, UnitedHealth Group is having a stellar year. The mammoth company, which is the largest health insurer in America and the biggest manager of private Medicare Advantage plans, announced on Thursday that despite a 14 percent decline in earnings, it had still made a profit of $2.1 billion — and that was just in the last fiscal quarter. UnitedHealth also won a major policy victory at the beginning of this month when the Obama Administration reversed course on its plan to cut reimbursements to Medicare Advantage plan providers by two percent. In fact, the Administration went the entirely opposite direction and announce it would raise these rates by 3.3 percent — a swing of 5.3 percent in UnitedHealth’s favor. Apparently, that isn’t enough for the insurance company. UnitedHealth is now threatening to reduce its involvement in managing Medicare plans, claiming that its government reimbursements are still too low.

“We did not expect the fastest growing, most popular and most effective Medicare benefit option serving America’s seniors to be underfunded to this extent in 2014,” UnitedHealth Group CEO Stephen Hemsley said on a conference call with investment analysts. He went on to clarify that the company will likely have to pull out of the Medicare market as it “reshape[s] Medicare networks and benefits to respond to the continuing underfunding of this [Medicare Advantage] program.” But Hemsley’s claims conflict with the company’s own earnings report, as well as the questionable performance of private insurance plans that service Medicare beneficiaries.

Conservatives often claim that having private insurers, rather than a public entity, manage programs like Medicare helps cut costs and make care more efficient. That’s why they have held up programs like Medicare Advantage and used it as a model for dismantling traditional Medicare to turn the public entitlement into a private insurance voucher. But as numerous studies and government reports have shown, private insurers game the Medicare Advantage program as much as they can by encouraging seniors to cherry-pick their health plans relative to their health. That allows companies like UnitedHealth to pay out less in benefits by offering healthier seniors alluring rates — but it raises prices for everybody in the traditional Medicare program by siphoning off less costly beneficiaries. And yet, Medicare Advantage still consistently comes in over-budget while regular Medicare manages to save money. Profit-motivated announcements like UnitedHealth Group’s today help explain why that is.

Obamacare contains cuts to these excess payments to private providers, consequently preserving the more generous and efficient traditional Medicare program. While those cuts are likely the source of Hemsley’s ire, he shouldn’t fret too much. Since Obamacare’s began being implemented, enrollment in Medicare Advantage has actually gone up, while seniors’ premiums have gone down.