Published: Sat, July 14, 2018
Medicine | By Melba Vasquez

Health Care Primer: The Sabotage And Retaliation Edition

Health Care Primer: The Sabotage And Retaliation Edition

"It is time to get the navigator application to launch", Seema Verma, the CMS administrator, stated in a press launch that mentioned the achievement of commercial agents in registering individuals and stressed the value of spending national funding more judiciously. That's because on Tuesday, CMS announced another major cutback to its health insurance counseling program.

Risk adjustment payments are meant to reduce the incentives for insurers to cherry-pick healthy consumers and weed out those with chronic illnesses and other preexisting conditions whose health costs are higher. That's why Obamacare included several provisions to help insurers cover the costs of the sickest patients - among them, the risk adjustment program. The industry warned that the government's failure to make the payments would likely push up premium rates on 2019 plans. The reality is sick people do rack up more health care costs. Without the steadying mechanism, that could destabilize the markets in the long term. A spokeswoman for ConnectiCare said the insurer is "monitoring developments" related to risk adjustment payments and plans to file its 2019 small group and individual plan rates next week. "This action will significantly increase 2019 premiums for millions of individuals and small business owners and could result in far fewer health plan choices", Serota said in a statement. The Kaiser Family Foundation estimates that 27 percent of people under the age of 65 have what could be considered a pre-existing condition.

The Trump administration just halted a key set of payments to Obamacare insurers, but it's consumers who could wind up having to foot the bill.

President Trump drastically slashed funding for the grassroots groups and nonprofits during his first year in charge of the program - from about $62 million under President Obama to $36 million.

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Publicly traded insurers with large presences in Obamacare include Centene Corp. and Molina Healthcare Inc.

Analysts were less certain than the industry about the impact of the payment interruption on insurers.

More than a dozen co-ops have failed since the ACA's implementation, and most have blamed the risk adjustment program. But the justification was flimsy - a ruling last February by a judge in New Mexico that the government's method of calculating the payments was flawed.

The court decision was "good for small and new health insurance companies, and therefore to anyone who purchases health insurance", said doctor Martin Hickey, the founder and former CEO of that insurer, New Mexico Health Connections.

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Oscar Insurance Corp., another startup, will enter six new markets. "It will attract more insurance companies because the risk adjustment will be more predictable and this increased competition will reduce rates". If there is an imbalance of high-risk customers among companies, the government uses a formula to redistribute money from less-burdened companies to more-burdened ones. "This is a time when consumers need more help to understand the insurance options that are available to them-not less".

"We are very discouraged by the new market disruption brought about by the decision to freeze risk adjustment payments", AHIP stated. The agency typically would give insurers information about their 2017 payments in June 2018, and then move the funds in the fall.

The federal agency's decision to suspend collections and payments until litigation is resolved is a short-term problem for Anthem, an insurer "that historically benefits from the risk adjustment program", Harris said.

"The administration already ended one program that helped keep premiums lower for consumers".

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An interim final rule goes into effect immediately, but can be altered later.

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