Trump admin temporarily halting some payments under Obamacare program

  • Trump admin temporarily halting some payments under Obamacare program

Trump admin temporarily halting some payments under Obamacare program

The program transfers funding from plans with lower-risk enrollees to higher-risk ones in an effort to even out the market and "encourage insurers to compete based on the value and efficiency of their plans rather than by attracting healthier enrollees", according to the Kaiser Family Foundation.

The president last fall also 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 medical services and bypass the law's rules meant to protect people from old insurance practices in which companies had charged higher prices to women, older people, and those with preexisting medical conditions. "It moves us back to some extent to the status quo where people with pre-existing conditions found it very hard to get insurance".

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

Under the risk adjustment program, insurers with healthier patients pay those with sicker patients.

"As the Exchange has grown in visibility and become more familiar to Americans seeking health insurance, the need for federally funded Navigators has diminished", CMS said in a statement on Tuesday.

America's Health Insurance Plans, the trade organization representing health insurers, issued a statement saying it was "discouraged" by the decision to freeze risk adjustment payments.

The U.S. Court for the District of New Mexico ruled the methodology used by the federal government to collect the payments was "arbitrary and capricious".

The Centers for Medicare and Medicaid Services said it had to put the payments on hold, after a USA district court judge ruled the government arrived at the formula that guides the payouts in a flawed way. But another district court in MA upheld the formula. "It will create more market uncertainty and increase premiums for many health plans - putting a heavier burden on small businesses and consumers, and reducing coverage options".

CMS was referring to a February ruling from a federal court in New Mexico that invalidated the risk adjustment formula, and a January ruling from a federal court in MA that upheld it.

Risk adjustment is a key aspect of market stabilization under the ACA, also known as Obamacare.

Democrats say that the cuts are more evidence of Trump officials sabotaging the health law.

The Republican Congress tried to repeal the Affordable Care Act at every turn in 2017 and now they are trying to take away the protection it provides for people with pre-existing conditions. Last year, the administration halted important subsidies for insurers. These include eliminating the individual mandate penalty and broadening the availability of two alternatives to Affordable Care Act policies. The insurers have requested average rate increases for 2019 that range from 18.5 percent to 91.4 percent, depending on the type of plan.