When they say they’ll “fight for insurance premiums not to go up” – it’s BS. They can’t.

Leave a CommentWhen they say they’ll “fight for insurance premiums not to go up” – it’s BS. They can’t.Commentary, Health, Politics

Here’s why they can’t reduce premiums. The fix is in and the insurers are running the game, holding all the cards.

The Centers for Medicare & Medicaid Services (CMS), the federal agency overseeing Medicare and Medicaid, sets reimbursement rates for medical services based on where care is provided, not through price negotiations.

Facilities classified as hospitals or hospital outpatient departments (HOPDs), like Banner Health (Arizona, mentioned in X post below but replicated across the nation), receive significantly higher reimbursement rates than independent practices for identical procedures. For example, a colonoscopy costing $1,500 at an independent practice might be reimbursed at over $4,000 when performed at a Banner facility, despite using the same equipment and often the same doctors. The difference lies solely in the billing code tied to the facility’s classification.

This site-of-service differential creates a financial incentive for hospital systems like Banner Health to acquire independent practices, which typically charge lower rates. Over time, this has led to significant consolidation in the healthcare industry, with independent physicians dropping from 70% of the workforce in 2010 to just 20% by 2025.

Once acquired, these practices stop billing as independent entities and adopt the hospital’s higher-rate billing codes. As a result, CMS and private insurers pay more for the same services, driving up healthcare costs and, consequently, insurance premiums for families and employers.

The issue is compounded because Banner Health operates its own insurance plans. When Banner’s insurance arm reimburses its hospitals at these inflated rates, it essentially funnels money—sourced from employer premiums, Medicare, and Medicaid—back to itself.

As a nonprofit, Banner pays no federal income tax, Arizona state tax, or property taxes, allowing it to amass significant financial reserves, pay executives millions, and continue acquiring competitors to charge monopoly-like prices.

Ultimately, the medicine remains unchanged—only the billing codes differ. CMS sets the rates based on facility classification, Banner collects the higher payments, and families bear the cost through rising premiums and taxes.

But wait! There’s more

They are finally admitting that Obamacare is an utter disaster. It failed. Miserably. Even the Bezos owned liberal Swamp rag, Washington Post, has finally had to admit Obama got the math wrong.