WH Suspends $10.4B in Obamacare Insurer Payments

11 July, 2018, 18:25 | Author: Sherman Richardson
  • Report: WH Suspends $10.4B in Obamacare Insurer Payments

The Centers for Medicare & Medicaid Services announced over the weekend that it was freezing billions of dollars in so-called risk adjustment payments for plans under the Affordable Care Act, also known as Obamacare, because of a court decision earlier this year that deemed the formula for determining these payments unlawful.

The Trump administration has halted billions of dollars of Obamacare payments to insurers due to a court ruling.

Major insurer groups said Saturday the administration's action interferes with a program that's working well.

"The executive order the president signed, not long after he got to the White House after the [Inaugural] Parade was effectively, 'We're declaring war on the Affordable Care Act.'" Whitlock says, the goal has been to make the marketplace as inhospitable as possible for participating plans, and this is just one more step in that direction.

But Senator Ron Wyden, the ranking Democrat on the Senate Finance Committee, said encouraging navigators to promote plans that don't comply with the ACA is "federally funded fraud: paying groups to sell unsuspecting Americans on junk plans that allow insurance companies to deny care on a whim and charge whatever they want is nothing but a scam".

The Congressionally mandated risk adjustment program of the Affordable Care Act redistributes funds from plans with lower-risk enrollees to plans with higher-risk enrollees, helping to ensure that sicker individuals can receive coverage by sharing the cost of covering them. However, Republican lawmakers and the Trump administration have made a series of moves meant to weaken the health law, such as halting subsidies that covered some consumers' out-of-pocket costs and eliminating the penalty for not having insurance.

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In February, U.S. District Judge James Browning in Albuquerque, N.M., ruled that the formula used by CMS to calculate payments in the risk-adjustment program was flawed and had not been adequately justified by federal regulators. The CMS has appealed the decision, particularly because a MA court upheld such payments.

"We were disappointed by the court's recent ruling", CMS Administrator Seema Verma said in the agency's statement.

The move sent shock waves through the insurance industry, which claimed that such market disruption could have near-immediate consequences for insured populations. The Maryland Insurance Administration has a hearing scheduled for July 31. Trump tweeted dozens and dozens of times about Obamacare and its demise previous year as he pushed the Senate to repeal the law. About 20 million Americans have received health insurance coverage through the programme.

"It has caused insurer collapses and market exits that reduced competition".

The news comes at a critical time for the Covered California exchange, which was set to announce rates for 2019 this month.

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