Trump admin expected to suspend some ObamaCare risk adjustment payments

09 Julio, 2018, 20:12 | Author: Earnest Bishop
  • Credit Kaiser Family Foundation

The Trump administration is halting billions of dollars of payments to insurers under the Affordable Care Act's risk-adjustment program, a move that further disrupts the insurance market and could lead to more premium increases next year. The payments insurers expected this fall, based on their 2017 business, amounted to $10.4 billion. Insurers say, the timing of the decision could mean higher premiums for millions of individuals and small businesses next year. The strategy is also used by Medicare private insurance plans. "It moves us back to some extent to the status quo where people with pre-existing conditions found it very hard to get insurance".

But U.S. District Judge James Browning of New Mexico ruled in February that HHS couldn't use statewide average premiums to come up with its risk-adjustment formula because the agency wrongly assumed the ACA required the program to be budget-neutral.

The program takes payments from insurers with healthier customers and redistributes the money to companies with sicker enrollees. "The decision will have serious consequences for millions of consumers who get their coverage through small businesses or buy coverage on their own", the group said. "It will undermine Americans' access to affordable coverage, particularly for those who need medical care the most". The risk-adjustment program has been a source of frustration for small insurers and ACA co-ops that claim the formula makes their membership bases look healthier than they are.

The suspension of the payments comes amid other efforts by the Trump administration to try to chip away at the landmark health care law.

Trump and his team have continued to argue that the individual mandate is unconstitutional and has promised to refuse to defend any parts of Obamacare in court. In October 2017, the White House announced it would end Obamacare cost-sharing payments that helped lower-income enrollees pay for health care.

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The mainstream media report offered more criticism from supporters of the Affordable Care Act.

But supporters of the ACA criticized the CMS announcement as the latest move by the Trump administration to undermine Obamacare.

Trump continues to attack Obamacare even as almost a dozen insurers have started to warm to the program with at least a dozen states seeing an increase in the number of insurers participating in the healthcare exchange.

These moves are prompting some insurers to request premium hikes for 2019 in the double digits.

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