Insurers See 'Uncertainty' From Trump Administration Payment Halt

Insurers See 'Uncertainty' From Trump Administration Payment Halt

"Risk adjustment payments" protect companies that insure a disproportionate number of people who need the most expensive health care. FierceHealthcare subscribers rely on our suite of newsletters as their must-read source for the latest news, analysis and data impacting their world.

In announcing the funding cuts, CMS said in a news release that navigators "failed to enroll a meaningful amount of people" on the federal marketplace and "not almost enough to justify the millions of federal dollars spent on the program". Many insurers that enroll large numbers of unhealthy people depend on the "risk adjustment" payments, which are meant to reduce the incentives for insurers to seek out healthy consumers and shun those with chronic illnesses and other pre-existing conditions. The reality is sick people do rack up more health care costs. After three years, two programs expired, with only the risk adjustment program permanent as stipulated by the law.

Kavanaugh would not only be a critical vote on Texas, but also on dozens of health care cases pending in the lower courts which are likely to be appealed to the Supreme Court in upcoming terms. Many have started making a profit and some are expanding their involvement for 2019, a marked change from this time previous year, when several carriers said they were going to pull out of the exchanges for 2018.

Seema Verma, administrator of the Centers for Medicare and Medicaid Services, listens during a meeting on healthcare reform at the White House.

Now, months later, CMS has asked the New Mexico judge to reconsider the decision, and in the meantime, it suspended the program.

The cost of any increase in premiums that results from the risk adjustment payments may come from taxpayer dollars. The administration is also pushing to broaden the definition of short-term insurance, which is also exempted from the ACA's rules.

Target Field Will Suspend Sale of Papa John’s Pizza
Papa John's founder John Schnatter says his use of a racial slur was taken out of context, but he feels "sick" about the incident. Not only is he featured in many TV commercials, but his face is emblazoned on pizza boxes and at the center of the logo.

The Trump administration just halted a key set of payments to Obamacare insurers, but it's consumers who could wind up having to foot the bill. United States, the administration followed 20 Republican state attorneys general arguing that the ACA's protections for people with preexisting conditions should be invalidated, which would strip health care from 52 million Americans including cancer patients, people with diabetes and pregnant women. This introduces uncertainty into the ACA markets just as insurers are deciding next year's rates.

CareSource, which will offer insurance in 79 of Indiana's 92 counties in 2019, would have gone from being a net receiver of money from the pool to paying about $16 million a year to other insurers - that is, until the freeze went into effect. The Republican Congress failed to repeal it, so the Trump administration has redoubled its efforts to gut it.

So the suspension of risk adjustment payments could throw the rate-filing process into chaos, said Cynthia Fox, director of health reform and private insurance at Kaiser Family Foundation.

She said the problem with reducing consumer assistance is not so much that fewer people will buy coverage but that people will buy policies that don't fit their needs.

The payments can be controversial, Dai said.

Now that the risk adjustment payments are on hold, some state regulators fear that insurers could become less willing to participate in certain communities.

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