|
 The Affordable Care Act's (ACA) "risk adjustment" program is
intended 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 ones.
President Donald Trump's administration has used its regulatory
powers to undermine the ACA on multiple fronts after the
Republican-controlled Congress last year failed to repeal and
replace the law propelled by Democratic President Barack Obama.
About 20 million Americans have received health insurance coverage
through the program known as Obamacare.
America's Health Insurance Plans (AHIP), a trade group representing
insurers offering plans via employers, through government programs
and in the individual marketplace, said the CMS suspension would
create a "new market disruption" at a "critical time" when insurers
are setting premiums for next year.
"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. And costs for taxpayers
will rise as the federal government spends more on premium
subsidies," AHIP said in a statement.
It could also encourage more insurers to bow out of Obamacare.
"This is occurring right at the time of year that people (insurers)
are making decisions about whether to participate in the exchanges
and what premiums to charge if they do," said Eric Hillenbrand, a
managing director at consultancy AlixPartners. "This will affect
their thinking on both of those decisions."
The Centers for Medicare and Medicaid Services (CMS), which
administers ACA programs, said on Saturday that months-old
conflicting court rulings related to the risk adjustment formula
prevent them from making payments.
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 Massachusetts that upheld it.
[to top of second column] |
CMS administrator Seema Verma said in a statement the administration
was "disappointed" in the February ruling and that CMS has asked the
court to reconsider and "hopes for a prompt resolution that allows
CMS to prevent more adverse impacts on Americans."
But supporters of the ACA criticized the CMS announcement as the
latest move by the Trump administration to undermine Obamacare.
"We urge the Trump administration to back off of this dangerous and
destabilizing plan, and instead begin working on bipartisan
solutions to make coverage more affordable," said Brad Woodhouse,
the executive director of Protect Our Care, a progressive group that
supports Obamacare.
The administration has made several other moves in recent years to
scale back or halt implementation of certain aspects of the ACA.
Late last year, it said it would halt so-called cost-sharing
payments, which offset some out-of-pocket healthcare costs for
low-income patients.
It has also scaled back the advertising budget for Obamacare
healthcare plans during the open-enrollment period by about 90
percent.
"What you are effectively doing is dismantling pieces of [the ACA]
without replacing them," Hillenbrand said. "It moves us back to some
extent to the status quo where people with pre-existing conditions
found it very difficult to get insurance."
(Additional reporting by Yasmeen Abutaleb in Washington; Editing by
Mary Milliken and James Dalgleish)
[© 2018 Thomson Reuters. All rights
reserved.] Copyright 2018 Reuters. All rights reserved. This material may not be published,
broadcast, rewritten or redistributed.
Thompson Reuters is solely responsible for this content. |
