Health Care Primer: The Sabotage And Retaliation Edition

Credit Kaiser Family Foundation

The Affordable Care Act's (ACA) "risk adjustment" program is meant to incentivize health insurers to cover individuals with pre-existing and chronic conditions by collecting money from insurers with relatively healthy enrollees to offset the costs of other insurers with sicker enrollees. Known as the risk adjustment program, it allocates insurance premium dollars to plans that enrolled higher risk and less healthy members from plans that enrolled lower risk and healthier members. Also, the $16 million payment (for the 2017 plan year) is temporarily on hold, per CMS's order.

America's Health Insurance Plans, the main health insurance industry trade group, said in a statement that it is "very discouraged" by the Trump administration's decision to freeze payments. Health law experts are...

Every action the Trump administration has taken on Obamacare suggests that's their goal. The nonprofit insurer sued the government in 2016 claiming the risk adjustment program unfairly penalized smaller insurers.

The administration argued in its announcement that its hands were tied by conflicting court rulings in New Mexico and MA.

Some have said CMS is being deliberately disruptive because of its hostility to ObamaCare, and that government programs should not be at the mercy of a lone federal judge.

The ambiguity involved in the conflicting New Mexico and MA rulings may mean the suspension of payments will indeed be temporary. Typically, agencies publish proposed rules to allow time for public comment before they go into effect.

Nonetheless, the timing is problematic. Initial reports of sky-high premium increases have been offset somewhat by more recent reports of moderate increases, according to data from Kaiser Family Foundation. Small insurers often complain about risk adjustment payments because they end up paying their larger competitors, who tend to have the sickest patients. Rate filings by CT health insurers for 2019 are due next week. "It is important to keep in mind that the original risk adjustment payments are budget-neutral such that for some insurers to win, other insurers have to lose".

The suspension of risk adjustment payments won't matter to people who quality for income-based federal subsidies, which rise along with premium costs.

If the individual mandate is ruled unconstitutional, private insurance companies could revert to rejecting people with many conditions-including heart disease, cancer, diabetes and a host of less serious health problems-or charging them exorbitant rates for coverage.

The spending cut is only one shift that CMS announced Tuesday.

Not only is the administration gutting the program, it's making them help people enroll in the plans Trump has concocted that don't comply with the consumer protection standards and other requirements of the law.

The $10 million will be available to the 34 states that use the Federally-facilitated Exchange Navigator Program, which enables participants to find their optimal coverage package for Obamacare enrollment, which begins this fall.

Navigators applying for the federal money will now be asked how they educate customers on new alternatives to the ACA that were put in place by the Trump administration.

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