Insurers See 'Uncertainty' From Trump Administration Payment Halt

Grant Boone
July 14, 2018

The payments were created to stop insurers from losing money on very sick patients, who cost the most to treat.

The elimination of risk adjustment funds also comes as Maryland officials await a decision from CMS on another funding mechanism they believe would help stabilize the market and provide money to insurers to help pay for expensive patients.

Trump's administration has used its regulatory powers to undermine the ACA on multiple fronts after the Republican-controlled Congress past year failed to repeal and replace the law instituted by Democratic President Barack Obama.

Frank Pallone called the cuts more "sabotage" from the administration.

America's Health Insurance Plans, the main health insurance industry trade group, said in a statement that it is "very discouraged" by the Trump administration's decision to freeze payments.

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The charges were announced on Friday by Deputy Attorney General Rod Rosenstein. Rosenstein briefed President Trump on the coming indictment earlier this week.

The president last fall issued an executive order to try to make it easier for individuals and small businesses to buy health plans that cost less than ACA coverage because they cover fewer services and bypass rules meant to protect people from previous practices in which insurers charged higher prices to women, older people and those with pre-existing medical conditions. He warned of "turmoil" as insurers finalize their rates for 2019. The agencies in a statement said that they were seeking legal redress and understanding and will be informing all the involved participants of any bring up-to-date information regarding the current collections or future payments at the right time.

CMS estimates that ACA navigators that received over $36 million enrolled less than one percent of the consumers that bought a health plan through an FFE. That's because many ACA customers will qualify for federal government premium subsidies, which are still alive and well in Obamacare.

Medicare and Medicaid Administrator Seema Verma said the Trump administration was disappointed by a New Mexico court ruling that questioned the workings of the risk program for insurers. In addition, both President Donald Trump and Senate Majority Leader Mitch McConnell have, in the past, supported the idea that insurers should not consider preexisting conditions when delivering coverage. The CMS has appealed the decision, particularly because a MA court upheld such payments. The other half are covered by expanded Medicaid. But the White House never produced a proposal, and legislation from congressional Republicans would have left millions uninsured, while undermining protections for people with pre-existing health problems.

Democrats were quick to denounce the administration's latest action. Sen. The nonpartisan Congressional Budget Office estimates that will raise premiums by about 10 percent.

Since efforts in Congress to repeal Obama's signature health care law failed, the Trump administration to pursue administrative changes to chip away at the 2010 law. Taken together, these moves will have the effect of damaging the ACA's marketplaces by attracting younger, healthier people, while forcing older, sicker people to either pay more for insurance or purchase sub-par insurance that might not cover services they need.

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