Trump administration halts billions in insurance payments under Obamacare

Trump admin expected to suspend some ObamaCare risk adjustment payments: report | TheHill

Trump admin expected to suspend some ObamaCare risk adjustment payments: report | TheHill

President Donald Trump's administration is freezing billions of dollars in payments to health insurers under the Affordable Care Act's risk adjustment program.

CMS says the New Mexico court's ruling bars "CMS from collecting or making payments under the current methodology, which uses the statewide average premium".

The Blue Cross Blue Shield Association, a federation of 36 Blue Cross and Blue Shield companies nationwide, also expressed disapproval at the move, saying it could create "turmoil" in the market. Through the program, roughly 20 million Americans have received health care coverage.

America's Health Insurance Plans (AHIP), a trade group representing insurers offering plans via employers, through government programs and in the individual marketplace, said the CMS suspension would create a "new market disruption" at a "critical time" when insurers are setting premiums for next year.

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.

"We were disappointed by the court's recent ruling", Seema Verma, administrator for the Centers for Medicare and Medicaid Services (CMS), which administers the program, told The Wall Street Journal in a statement. "This decision will have serious consequences for millions of consumers who get their coverage through small businesses or buy coverage on their own".

The CMS statement said the agency will "provide additional guidance shortly on how it will handle other issues relating to risk adjustment payments".

"We urge the Trump administration to back off of this unsafe and destabilizing plan, and instead begin working on bipartisan solutions to make coverage more affordable", said Brad Woodhouse, the executive director of Protect Our Care, a progressive group that supports Obamacare. To do that, the government collects money from health insurers with enrollees who were healthier and as a result "cost less to insure".

Risk-adjustment made up one of the "three R's" that constitute Obamacare's program to stabilize healthcare markets, as the program causes insurers with healthier customers to reimburse insurers with more expensive and sicker enrollees.

The ripple comes at a pivotal time for the Affordable Care Act's marketplace. Some insurances have even expanded their presence in states where they were already operating with help from the Affordable Care Act.

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