Trump administration suspends ACA risk-adjusted payments

13 July, 2018, 22:57 | Author: Kara Nash
  • Another challenge for Obamacare — and a bigger bill for taxpayers

The cuts to grass-roots groups around the country was announced three days after health officials revealed that, because of a pending lawsuit, they were suspending a program created by the law to even out the burden on health insurers whose customers are especially unhealthy or sick. Sign up today to get healthcare news and updates delivered to your inbox and read on the go.

The Centers for Medicare & Medicaid Services announced Tuesday that it would provide only $10 million for the navigator program for this fall's open enrollment season. They assisted 42% of enrollees, the agency said.

The Trump administration says the freezing of these payments is based on a ruling by a federal judge in Albuquerque, New Mexico, who ruled that part of risk adjustment provision's implementation was flawed and hadn't been adequately justified by federal regulators.

While imperfect, the risk adjustment program "has helped promote market stability over the past five years", Wehrle said. "This decision reflects CMS' commitment to put federal dollars for the Federally-facilitated Exchanges to their most cost effective use in order to better support consumers through the enrollment process", CMS Administrator Seema Verma said.

A federal judge in D.C.

While the move will prevent larger, institutional payers like Anthem from collecting millions of dollars from the program to pay for higher-need members, it could be a short-term boon for small plans and ACA co-ops, which have historically been on the paying end of the funding mechanism. A spokeswoman for ConnectiCare said the insurer is "monitoring developments" related to risk adjustment payments and plans to file its 2019 small group and individual plan rates next week.


The Trump White House has been busy separating migrant families and plotting the demise of Roe v. Wade in recent weeks, but don't worry: they haven't forgotten about their quest to make it harder for Americans to obtain adequate health insurance.

Trump's administration has used its regulatory powers to undermine the ACA on multiple fronts after the Republican-controlled Congress a year ago failed to repeal and replace the law instituted by Democratic President Barack Obama. Last year, in addition to reducing money to navigator groups, the Administration cut funding for promotion of the law by $90 million.

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

CMS was referring to a February ruling from a federal court in New Mexico that invalidated the risk adjustment formula, and a January ruling from a federal court in MA that upheld it. Rate filings by CT health insurers for 2019 are due next week. "In general, when there's uncertainty in the market, insurers will cushion themselves however they can", she said. The other two methods were temporary, but risk adjustment is permanent.

Technically, the administration has only suspended risk adjustment payments, not permanently ended them.

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.

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