USA freezes payments to ACA insurers with sicker patients

Trump Administration Halts Billions In Insurance Payments Under Obamacare

The decision could be a big financial hit for some insurers and may lead to higher insurance rates in some cases, critics say.

Just as more insurers and consumers were entering the ACA individual market and things seemed to be stabilizing, the Trump administration struck a new blow against the health-care sector over the weekend, cutting off the multi-billion dollar risk adjustment payments that compensate insurers for taking on sicker and more expensive patients.

CMS said it was "disappointed" by that decision and asked the judge to reconsider, which tends to be faster than the appeals process.

The risk-adjusted premium pool takes money from healthier patients paying for health care and redistributes it to the less healthy, more needy patients to pay for higher premiums.

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.

CMS plans to appeal the court's ruling, as the U.S. District Court for the District of MA ruled to uphold the payments. 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.

Insurance companies responded quickly on Saturday with their disapproval.

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The payments are meant to help stabilise health insurance markets by compensating insurers that had sicker, more expensive enrollees in 2017.

"This decision will have serious consequences for millions of consumers who get their coverage through small businesses or buy coverage on their own", America's Health Insurance Plans said. "It will undermine Americans' access to affordable coverage, particularly for those who need medical care the most". He says halting the risk adjustment program will disrupt the individual markets, and might even cause insurers not to participate next year.

The bottom line is that the Trump administration is making good on its promise to rid Americans of Obamacare, with or without the help of the legislature.

"We are very discouraged by the new market disruption brought about by the decision to freeze risk adjustment payments", AHIP stated.

Tell the Republican Congress and administration to quit playing politics with our health.

The move should not have been unexpected given the administration's disdain for other provisions of the Affordable Care Act (ACA), leading to the elimination of other key taxpayer-funded subsidies and the outright eradication of the individual mandate through this past winter's tax cut legislation. Last month the Department of Justice decided not to defend the law in a court challenge in Texas, jeopardizing the part of the law that protects people with pre-existing conditions from being denied coverage, as NPR reported.

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