Published: Fri, July 13, 2018
Medical | By Marta Holmes

Trump administration freezes "risk adjustment" payments to health insurers

Trump administration freezes

When the ACA was passed in 2010, one of the most important tenets of the law was the rule stating that insurers must accept all patients regardless of their health history. Sign up today to get healthcare news and updates delivered to your inbox and read on the go.

The Trump administration is bound by a federal court decision to suspend billions of dollars in ObamaCare payments, Centers for Medicare and Medicaid Services (CMS) Administrator Seema Verma said Thursday.

"Risk adjustment payments" protect companies that insure a disproportionate number of people who need the most expensive health care. The agency also said that the people confused by health insurance benefits can use insurance agents and brokers for help.

CMS said in a statement that the funds were being cut because people are more familiar with the exchange program, and that the programs enrolled less than 1% of participants a year ago.

More news: 'Pretty full on': Kiwi diver who helped rescue Thai cave boys

While imperfect, the risk adjustment program "has helped promote market stability over the past five years", Wehrle said.

"We're urging CMS to find a legal or regulatory path that allows immediate action to reinstate these payment transfers and ensure that coverage for millions of Americans is not disrupted", Kris Haltmeyer, vice president for legislative and regulatory policy at the Blue Cross Blue Shield Association, said in a statement.

The administration said navigators were not enrolling enough people to receive higher funding amounts. "ORCRP001017-topic.html" class="local_link" >Anthem Inc. and Cigna Corp., referred to the AHIP statement when asked about the impact of the federal payment interruption. The nonprofit insurer sued the government in 2016 claiming the risk adjustment program unfairly penalized smaller insurers. The program was also cut a year ago.

Last weekend, the administration announced it is freezing payments by an ACA program meant to stabilize premiums. The announcement comes in the midst of the annual rate-filing period when insurers announce their estimated premium prices and plans for coverage to state regulators.

More news: Politicians, Bollywood stars lose followers as Twitter goes on a clean-up drive

Citing two conflicting federal court cases on the use of statewide average premiums in its decision, CMS said it can not collect or redistribute funds for risk-adjusted payments. The Republican Congress failed to repeal it, so the Trump administration has redoubled its efforts to gut it.

More than 20 million people have coverage through former President Barack Obama's law. "It is important to keep in mind that the original risk adjustment payments are budget-neutral such that for some insurers to win, other insurers have to lose". "This comes at a time when the market was looking really strong for 2019, and insurers were coming off a very profitable year".

So the suspension of risk adjustment payments could throw the rate-filing process into chaos, said Cynthia Fox, director of health reform and private insurance at Kaiser Family Foundation. Navigators say some of the work they do, like with Medicaid, isn't counted by the government.

More than 10 million people buy individual health insurance plans through HealthCare.gov and state insurance marketplaces.

More news: Mueller Indicts 12 Russian Spies for Hacking in 2016 Campaign

Like this: