WH Suspends $10.4B in Obamacare Insurer Payments

Fargo North Dakota. President Trump held a campaign style

Once again, the Trump administration has taken an axe to the Affordable Care Act, temporarily suspending a program that was set to pay out $10.4 billion to insurers for covering high-risk individuals a year ago.

CMS provided a timeline, noting that after the February 28 decision by the New Mexico federal court, it filed a motion for reconsideration, and on June 21 the court held a hearing on it. CMS is waiting for the court's ruling, it said.

The administration has made several other moves in recent years to scale back or halt implementation of certain aspects of the ACA.

The Congressionally mandated risk adjustment program of the Affordable Care Act redistributes funds from plans with lower-risk enrollees to plans with higher-risk enrollees, helping to ensure that sicker individuals can receive coverage by sharing the cost of covering them.

"This action will significantly increase 2019 premiums for millions of individuals and small business owners and could result in far fewer health plan choices", Scott Serota, CEO of the Blue Cross Blue Shield Association, said in a statement.

Insurance is normally based on risk, with premiums costing more for clients who are expected to require more healthcare services. The agency said it will release additional guidance for insurers on issues related to the risk-adjustment program, including appeals and how this will affect medical loss ratios.

Levitt says the administration's announcement was "a little perplexing", given that the legal fight over the conflicting rulings in New Mexico and MA is still ongoing.

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"Normally you would expect an administration to look for ways to minimize the uncertainty and minimize the effect as these cases play out", he says.

But to Rodney Whitlock, Vice President of Health Policy at ML Strategies and former Republican congressional aide, it's not perplexing at all.

"We are extremely disappointed that the administration has frozen payment transfers under the Affordable Care Act's (ACA) risk adjustment program, which is created to keep costs down for consumers while meeting the medical needs of those requiring significant care", President and CEO Scott Serota said in a statement.

Indeed, a series of actions by the administration have undermined the ACA. Donald Trump's move to gut Obamacare guarantees it. Some insurances have even expanded their presence in states where they were already operating with help from the Affordable Care Act.

"The Trump administration just keeps pushing their destructive repeal-and-sabotage agenda, no matter the cost to the American people", Brad Woodhouse, the director of Protect Our Care, an advocacy group that supports Obamacare, stated in the New York Times report.

The administration is taking legal steps to challenge the ruling in New Mexico, says Levitt.

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