Trump admin expected to halt some payments under Obamacare program

The Trump administration said Saturday it's been forced to freeze critical Obamacare payments due to a federal court decision in New Mexico, potentially causing more instability in the program's fragile markets.

The federal court ruling prevents the agency, which administers the Obamacare risk-adjustment program, from making further collections or payments, including those for the 2017 benefit year, until the litigation is resolved, the agency said.

At stake is more than $10 billion in "risk adjustment" payments - a feature of the 2010 health law that requires insurers with healthier consumers to reimburse plans that end up with costlier, sicker patients, so the market balances out. "And costs for taxpayers will rise as the federal government spends more on premium subsidies". "It moves us back to some extent to the status quo where people with pre-existing conditions found it very hard to get insurance".

"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.

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

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

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 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. The government collects the money from health insurers with relatively healthy enrollees, who cost less to insure. "It will undermine Americans' access to affordable coverage, particularly for those who need medical care the most".

Risk adjustment is a key aspect of market stabilization under the ACA, also known as Obamacare.

FILE PHOTO: A man fills out an information card during an Affordable Care Act outreach event hosted by Planned Parenthood for the Latino community in Los Angeles, California September 28, 2013.

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