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Health Insurers Struggle With Sudden Freeze On ACA Payouts

11 July 2018, 06:26 | Randall Craig

Justin Sullivan Getty Images North America

Fargo North Dakota. President Trump held a campaign style

The Trump administration announced Saturday that it will temporarily halt billions of dollars in payments under the Affordable Care Act's risk adjustment program, a move that could shake up insurance markets.

Nationally, insurance industry officials quickly denounced the Trump administration's move and warned that the decision would drive up premiums.

The Trump administration has suspended more than $10 billion in Obamacare payments to insurance companies that lost money on state insurance exchanges.

"We were disappointed by the court's recent ruling". The payments work this way: The government takes money from insurers with healthier, low-risk customers, and gives it to insurers with less-healthy, higher-risk customers.

The idea is to remove the financial incentive for insurers to "cherry-pick" healthier customers. The government uses a similar approach with Medicare private insurance plans and the Medicare prescription drug benefit. About $10.4 billion was slated to be transferred past year.

New Mexico Health Connections and Minuteman Health of MA, two small nonprofit insurers, filed lawsuits in 2016, contending that the Obama administration created an inaccurate formula that unfairly rewarded large insurers.




The program is critical to markets under the Affordable Care Act because insurers with healthier consumers enrolled in plans reimburse insurers with sicker and more expensive enrollees. "It will create more market uncertainty and increase premiums for many health plans - putting a heavier burden on small businesses and consumers, and reducing coverage options", AHIP said.

Dr. Dave Weldon, president of the Alliance of Health Care Sharing Ministries, discusses why health care sharing ministries could be a good alternative for people who can't find affordable health care.

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.

Serota noted that the payments are required by law, and said he believes the administration has the legal authority to continue making them despite the court cases. Health law experts are...

But Senator Ron Wyden, the ranking Democrat on the Senate Finance Committee, said encouraging navigators to promote plans that don't comply with the ACA is "federally funded fraud: paying groups to sell unsuspecting Americans on junk plans that allow insurance companies to deny care on a whim and charge whatever they want is nothing but a scam".

The pro-ACA group Protect Our Care issued a statement from its executive director, Brad Woodhouse, Saturday after the administration announced its decision regarding risk penalty payments, characterizing the move as further chipping away at the Affordable Care Act.



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