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In the midst of a deep economic recession, America’s health insurance companies increased their profits by 56 percent in 2009, a year that saw 2.7 million people lose their private coverage.The nation’s five largest for-profit insurers closed 2009 with a combined profit of $12.2 billion, according to a report by the advocacy group Health Care for American Now (HCAN).

Last Tuesday, some thirty people attended a hearing at the Missouri Division of One Sure Insurance. At issue was a request by five Missouri health insurance companies that they be granted an adjustment in a requirement of the new health care law, taking effect this year. That rule, the Medical Loss Ratio, specifies that companies spend 80-85 percent of the money they take in on actual health care. These five say that hurdle is too high, that they can’t get across it. Three of the companies are close to meeting the requirement; two are not. A problem that commission members will confront in ruling on the requested waiver is that Missouri, like two other states, does not require that health insurance companies be transparent about where their health care dollars are spent. And they haven’t been.

Amy Smoucha of Jobs with Justice, got eight activists from various consumer health care groups to attend and testify. These folk were there to remind the members of the commission that the health care industry is one of the most profitable in the country. I don’t know exactly which examples those activists presented, but here’s one that struck me: UnitedHealth Group paid its CEO, Stephen Hemsley,  $7.5 million in salary for 2009. But with stock options of $98.5 million, Hemsley’s take that year was $106 million. That may be a teensy fraction of the company’s overall expenditures, but it tells us that health insurers aren’t feeling any pinch in this economy. If they can’t spend at least 80 percent of what they take in on health care, then maybe the Hemsleys and the shareholders need to tighten their belts a notch. They’ll still have a 48 inch waist.

One of the activists who testified, Rea Beck Kleeman is an M.D., a psychiatrist. She pointed out that only one representative of the insurance companies, a lobbyist for United Health Care, attended. And he seemed, as Kleeman put it “challenged in some of the facts that he brought up.”

Since the head of the commission was appointed by Nixon, there’s some reason to be optimistic that the commission members will keep in mind the ample evidence supporting the contention that health insurance companies are among the fattest fiscal cats in the nation. Let’s further hope that the unsupported word of the far-from-fiscally-transparent companies that they can’t afford to spend that much on health care rings false to the commissioners.

Here’s something we know: Missouri health care advocates will keep a close eye on this issue. And if the situation warrants, they will bust butt and perhaps ask for our help in guarding this important consumer protection.