Insurers urge quick fix to halted ACA payments

At stake are billions in payments to insurers with sicker customers.

For the second time in days, the Trump administration is taking action to undercut the Obama-era Affordable Care Act.

On Saturday, the administration said it would suspend a program that was set to pay out $10.4 billion to insurers for covering high-risk individuals under Obamacare past year, saying that a recent federal court ruling prevents the money from being disbursed. Without this program, insurers might have taken on less risk in the market, especially in rural counties.

Molina, on the other hand, won't have to send almost $1 billion, while Centene can avoid paying hundreds of millions of dollars to the program ... at least for now, JPMorgan projected. No taxpayer subsidies are involved. It discourages companies from trying to save money by cherry-picking the healthiest people and kicking others to the curb.

Blue Cross Blue Shield Association President and CEO Scott Serota said the administration has the legal justification needed to move forward with the payments regardless of the New Mexico ruling. Almost 9 in 10 people buying coverage on the ACA exchanges qualify for federal subsidies based on their incomes, and the amount those subsidies rose previous year because of an increase in silver-plan premiums.

Officials with CareFirst BlueCross BlueShield, one of two Maryland insurers that sell Affordable Care Act plans, said they need the payments to keep that part of their business afloat. Rate filings by CT health insurers for 2019 are due next week.

The Centers for Medicare & Medicaid Services announced over the weekend that it was freezing billions of dollars in so-called risk adjustment payments for plans under the Affordable Care Act, also known as Obamacare, because of a court decision earlier this year that deemed the formula for determining these payments unlawful. Premiums undoubtedly will rise, and more people will be unable to afford them.

Also last month, the Trump administration announced it was releasing rules making it easier for small businesses and self-employed individuals to buy insurance plans that do not comply with Obamacare's regulations. But the Saturday announcement via email was unusual for such a major step. "CMS has asked the court to reconsider its ruling, and hopes for a prompt resolution that allows CMS to prevent more adverse impacts on Americans who receive their insurance in the individual and small group markets".

The announcement also said navigators helped enroll fewer than 1 percent of the almost 12 million Americans who signed up for ACA coverage for 2018 - a figure that navigators contend understates their accomplishments.

But despite President Donald Trump's disdain for "Obamacare", enrollment for subsidized private coverage has been fairly steady, with about 10 million people now signed up.

Since then, the Labor Department has issued a rule to broaden the use of one such kind of insurance, called "association health plans".

The brunt of higher prices would fall on solid middle-class consumers who are not eligible for the income-based subsidies. If there is an imbalance of high-risk customers among companies, the government uses a formula to redistribute money from less-burdened companies to more-burdened ones.

The latest "Obamacare" flare-up does not affect most people with employer coverage.

"The truth is that the Trump administration has lots of options".

There has been no demonstrable outrage from leading Democrats on Trump's intensifying campaign to transform Medicaid into a cut-rate voucher program or other aspects of the administration's crusade against the poor and dismantling of what remains of the social safety net.

"Investors should read headlines about the delay in risk adjustment payments cautiously", she said. Immediately after Sen. John McCain (R-Ariz.) cast the deciding vote to block the dramatic repeal effort, Trump implored Republicans to let the law disintegrate.

Vanessa Coleman

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