The Centers for Medicare and Medicaid Services announced that it would suspend $10.4 billion in risk adjustment payments, which are created to compensate insurers that enroll sick, expensive patients. No taxpayer subsidies are involved. 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.
On Saturday, the administration said it would suspend a program that was set to pay out $10.4 billion to insurers for covering high-risk individuals under Obamacare past year, saying that a recent federal court ruling prevents the money from being disbursed.
Over the weekend, the administration said it would freeze risk adjustment payments to insurers that cover a large amount of unhealthy consumers - payments meant to stabilize the marketplace by offsetting higher costs associated with riskier patients.
She noted the Trump administration views state flexibility as important, and is committed to granting as much of it as possible. The move is the latest effort by the Trump administration to undermine the Affordable Care Act.
They say the moves will siphon healthier customers out of the Obamacare markets, raising premiums for everyone, and that Republicans will pay a political price for the moves in this November's mid-term elections. In January a federal court in MA ruled the formula wasn't arbitrary and capricious.
CMS estimates that ACA navigators that received over $36 million enrolled less than one percent of the consumers that bought a health plan through an FFE.
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Verma is right, just look at the disgusting recruitment results of these navigators over the past few years.
The latest "Obamacare" flare-up does not affect most people with employer coverage. "CMS has asked the court to reconsider its ruling, and hopes for a prompt resolution that allows CMS to prevent more adverse impacts on Americans who receive their insurance in the individual and small group markets". Verma said the administration is defending the risk adjustment regulation, even though it was written under the Obama administration. The other half are covered by expanded Medicaid. The Kaiser Family Foundation estimates that 27 percent of people under the age of 65 have what could be considered a pre-existing condition. John McCain, R-Ariz., cast a crucial "no" vote, with a thumbs down gesture that's become a target of Trump criticism at campaign-style rallies.
Signaling the administration's long-term objectives, Andrew Bremberg, who oversees domestic policy at the White House, told reporters past year, "The president still firmly believes that Congress must act to repeal and replace Obamacare, but before that can be done, this administration must act to provide relief". The nonpartisan Congressional Budget Office estimates that will raise premiums by about 10 percent.
When the ACA was passed in 2010, one of the most important tenets of the law was the rule stating that insurers must accept all patients regardless of their health history.
Navigators have been on the forefront on ACA enrollment for five years in North Carolina.