Trump administration freezes risk adjustment payments

Trump administration freezes risk adjustment payments

Health insurers warned that a move by the Trump administration on Saturday to temporarily suspend a program that was set to pay out $10.4 billion to insurers for covering high-risk individuals previous year could drive up premium costs and create marketplace uncertainty.

CMS, which is overseen by the U.S. Department of Health and Human Services, said the move was necessary because of a February ruling by a federal court in New Mexico, which found that the federal government was using an inaccurate formula for allocating the payments. The CMS said it won't be making transfer payments for the 2017 benefit year totaling $10.4 billion. 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.

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

In the meantime, some health insurers are potentially out billions of dollars.

Trump tweeted dozens and dozens of times about Obamacare and its demise past year as he pushed the Senate to repeal the law. "And costs for taxpayers will rise as the federal government spends more on premium subsidies", the group said.

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The Trump administration's move "will significantly increase 2019 premiums for millions of individuals and small business owners and could result in far fewer health plan choices", association president Scott Serota said in a statement. Through the program, roughly 20 million Americans have received health care coverage. The agency says the court ruling also prevents it from collecting additional risk-adjustment funds until the issue is resolved.

Medicare and Medicaid Administrator Seema Verma said the Trump administration was disappointed by a New Mexico court ruling that questioned the workings of the risk program for insurers.

The main insurance trade associations in Washington have been organizing calls with their member companies and trying to coordinate a response. Donald Trump's move to gut Obamacare guarantees it.

"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. These include eliminating the individual mandate penalty and broadening the availability of two alternatives to Affordable Care Act policies. "There is a need to analyze insurers case-by-case and account for their competitive landscapes", said Tinglong Dai, an associate professor of operations management and business analytics at the Johns Hopkins University Carey Business School.

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