Health Care Primer: The Sabotage And Retaliation Edition

10 July, 2018, 21:23 | Author: Sherman Richardson
  • Credit Kaiser Family Foundation

The Centers for Medicare and Medicaid Services said it had to put the payments on hold, after a US district court judge ruled the government arrived at the formula that guides the payouts in a flawed way. The payments work this way: The government takes money from insurers with healthier, low-risk customers, and gives it to insurers with less-healthy, higher-risk customers. The permanent program was meant to reduce the incentive for health insurers to cherry-pick healthy members. "In light of this analysis, the Government can not lawfully make the cost-sharing reduction payments", the White House said after ending the payments in October 2017. In a statement America's Health Insurance Plans, the trade association for health insurance companies, said they are "very discouraged by the new market disruption brought about by the decision to freeze risk adjustment payments". Through the program, roughly 20 million Americans have received health care coverage. "It will undermine Americans' access to affordable coverage, particularly for those who need medical care the most".

While imperfect, the risk adjustment program "has helped promote market stability over the past five years", Wehrle said.

Trump administrators suspended the payments over a February ruling by a federal district court in New Mexico, according to the reports.

CMS plans to appeal the court's ruling, as the U.S. District Court for the District of MA ruled to uphold the payments.

The pro-ACA group Protect Our Care issued a statement from its executive director, Brad Woodhouse, Saturday after the administration announced its decision regarding risk penalty payments, characterizing the move as further chipping away at the Affordable Care Act.

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Insurance companies responded quickly on Saturday with their disapproval. The Maryland Insurance Administration has a hearing scheduled for July 31.

More broadly, the move contributes to a string of actions from the Trump administration, including the cancellation of other ObamaCare payments previous year, that have added to insurers' uncertainty and frustration. Legacy insurers that have a wealth of patient data may have a leg up on coding. The White House supported two attempts in Congress past year to repeal the program, which insures about 20 million Americans. Some insurances have even expanded their presence in states where they were already operating with help from the Affordable Care Act.

Insurance Commissioner Al Redmer Jr. said that as of now he doesn't expect the latest decision to interrupt the state's rate-setting process.

"People spin the administration's decision as Trump trying to do harm, but it's exactly the opposite", he added.

These moves are prompting some insurers to request premium hikes for 2019 in the double digits.

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