Monday, 24 September, 2018

Trump Administration Freezes Payments Required By The Affordable Care Act

Report: WH Suspends $10.4B in Obamacare Insurer Payments Trump administration halts billions in insurance payments under Obamacare
Ben Pena | 11 July, 2018, 18:27

"Suspending the Risk Adjustment Program is the Trump administration's latest attempt to do administratively what they couldn't do legislatively: dismantle the Affordable Care Act", he said.

CMS was referring to a February ruling from a federal court in New Mexico that invalidated the risk adjustment formula, and a January ruling from a federal court in MA that upheld it.

In the meantime, some health insurers are potentially out billions of dollars.

The idea is to remove the financial incentive for insurers to "cherry-pick" healthier customers.

The risk-adjustment program, which does not cost taxpayers any money and is required by law, is created to ensure that health care coverage is available for sicker, higher-cost patients by sharing the cost of covering them. The program is based on a patient's risk score, which is determined by a person's demographic information and health condition.

On Thursday the Centers for Medicare and Medicaid Services (CMS) announced the latest effort to send ACA markets into the proverbial death spiral. The vast majority of those customers receive taxpayer subsidies under the Obama-era health law and would be shielded from premium increases next year.

"This decision will have serious consequences for millions of consumers who get their coverage through small businesses or buy coverage on their own".

Hurricane Chris forms; not expected to make US landfall
Tropical Storm Chris is now tracking the East Coast of the United States and is set to cross the Atlantic to the UK. Friday and Saturday our July thunderstorms return mainly late in the afternoon with highs in the lower 90s.

"So much uncertainty put in the market at this point of time is very unnerving", said Ritu Agarwal, senior associate dean of research at the University of Maryland Robert H. Smith School of Business, who follows the health care system.

Risk adjustment is an important part of the ACA. Legacy insurers that have a wealth of patient data may have a leg up on coding.

Officials with Kaiser Permanente, the state's other insurer with Affordable Care Act plans, have raised concerns about the risk adjustment program but disagreed with the suspension of the payments. "This decision reflects CMS' commitment to put federal dollars for the Federally-facilitated Exchanges to their most cost effective use in order to better support consumers through the enrollment process", CMS Administrator Seema Verma said.

In justifying the cuts, CMS said the program is an "established marketplace" heading into its sixth year, so many people are more familiar with it.

Since then, it has taken administrative steps to weaken the law, including the removal of the individual mandate - which required everyone to purchase health insurance. The insurers have requested average rate increases for 2019 that range from 18.5 percent to 91.4 percent, depending on the type of plan.

"The risk adjustment formula was extremely biased in favor of large, established insurers and discriminated against new and small insurers, including co-ops like ours", Hickey told The New York Times on July 7.

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