ibusinesslines.com November 21, 2018

Trump administration takes another swipe at 'Obamacare' program

14 July 2018, 09:14 | Melissa Porter

Credit Kaiser Family Foundation

Credit Kaiser Family Foundation

The Trump administration announced Saturday evening that it is temporarily freezing billions of dollars of payments to health insurance companies meant to help them manage higher-risk patients, sparking backlash from the industry's lobbying arm as insurers continue to struggle to adjust to the administration's repeated attacks on Obamacare.

The healthcare sector remains in flux as policy, regulation, technology and trends shape the market. Under the risk adjustment program, insurers with healthier policyholders contribute money, which is then divvied up among carriers with sicker ones. The assault on pre-existing condition protections may make its way to the Supreme Court soon, and if Brett Kavanaugh is sitting on the bench, affordable health care for all will be at serious risk.

"We are very discouraged by the new market disruption brought about by the decision to freeze risk adjustment payments". "It enables the country to move away from a market where plans compete to avoid covering or charge more to people with preexisting health conditions, to one where competition is based on quality, affordable care for everyone".

The court decision was "good for small and new health insurance companies, and therefore to anyone who purchases health insurance", said doctor Martin Hickey, the founder and former CEO of that insurer, New Mexico Health Connections. The Republican Congress failed to repeal it, so the Trump administration has redoubled its efforts to gut it. But the Trump administration is hanging its decision to withhold subsidies to insurers on court decisions from New Mexico and MA which say the way those payments are handed out is too vague. "As a result of this litigation, billions of dollars in risk adjustment payments and collections are now on hold".

This reduction comes a year after the Trump administration decreased navigators' funding by 40 percent from $62.5 million - and cut advertising and other outreach activities.

Health insurers say it is a move that could drive up premium costs and create marketplace uncertainty.

In February, however, the federal district judge in New Mexico issued a decision voiding the formula used in calculating risk adjustment payments for the 2014-2018 benefit years.

CMS said it was "disappointed" by that decision and asked the judge to reconsider, which tends to be faster than the appeals process. Her insurer, Oscar, is boosting rates again for 2019, and Williams is slated to see an increase to $518.33 for a low-level bronze plan.

"Costs for taxpayers will rise as the federal government spends more on premium subsidies", the group said.

"Given the continued attacks on health care, including federal rules allowing the resurgence of low-priced, junk health insurance plans, such as "association health plans" and "short-term plans", consumers looking for good, comprehensive coverage could be easily confused", said Frederick Isasi, executive director of Families USA, a left-leaning advocacy organization.

In the event that the delay in 2017 risk-adjustments becomes permanent, Kaiser Pemanente stands to gain the most, according to CMS data crunched by Axios' Bob Herman and Harry Stevens.

About 20 million Americans have received health insurance coverage through the program. The counselors, known as navigators, help consumers find an affordable health plan on the ACA exchanges. States also have to prove to CMS that navigators met enrollment goals and provided information to consumers about all possible health plan options.

CMS now wants the navigators to promote these policies in addition to steering people toward ACA-compliant plans and Medicaid.

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