Grants that help Americans get health care coverage slashed

Credit Kaiser Family Foundation

Credit Kaiser Family Foundation

This idea of pooling risk has had significant practical effects: encouraging insurers to participate in the insurance marketplaces the ACA created for Americans who can not get affordable health benefits through a job. Sign up today to get healthcare news and updates delivered to your inbox and read on the go.

The Affordable Care Act's (ACA) "risk adjustment" program is meant to incentivize health insurers to cover individuals with pre-existing and chronic conditions by collecting money from insurers with relatively healthy enrollees to offset the costs of other insurers with sicker enrollees. "The administration has said they were disappointed with the New Mexico ruling, and they want to work it out", said Greg Fann, consulting actuary for Axene Health Partners and fellow of the Society of Actuaries.

But the Trump administration is hanging its decision to withhold subsidies to insurers on court decisions from New Mexico and MA which say the way those payments are handed out is too vague. After three years, two programs expired, with only the risk adjustment program permanent as stipulated by the law.

"We're urging CMS to find a legal or regulatory path that allows immediate action to reinstate these payment transfers and ensure that coverage for millions of Americans is not disrupted", Kris Haltmeyer, vice president for legislative and regulatory policy at the Blue Cross Blue Shield Association, said in a statement. "Costs for taxpayers will rise as the federal government spends more on premium subsidies", said a statement from America's Health Insurance Plans, a health insurance industry trade group.

A federal judge in D.C.

The agency once again defended the decrease by saying that navigators, which usually hail from non-profit and community organizations, are not effective. In a surprise weekend announcement, the Trump administration temporarily suspended $10 billion worth of 2017 "risk adjustment payments". The CMS has appealed the decision, particularly because a MA court upheld such payments.

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It is unclear how many Americans are paying back some or all of the financial assistance they received to buy health insurance because their income turned out to be higher than they projected.

Larger insurers have called for CMS to quickly devise an alternative to risk-adjusted payments. Rate filings by CT health insurers for 2019 are due next week.

By the way, this rule was propagated by the Obama Administration, not President Trump. "There is a need to analyze insurers case-by-case and account for their competitive landscapes", said Tinglong Dai, an associate professor of operations management and business analytics at the Johns Hopkins University Carey Business School. With suspension of the risk adjustment payments, insurers must now contend with another disruption to the market by the time they finalize rates early this fall.

"I fear this latest decision, if it stands, will lead to fewer choices for consumers and higher premiums they would pay for health plans in 2019".

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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