Insurers scramble after Trump suspends billions in ObamaCare payments

10 Juillet, 2018, 06:24 | Auteur: Yves Courtet
  • Insurers scramble after Trump suspends billions in ObamaCare payments

Health insurers warned that a move by the Trump administration on Saturday to temporarily suspend a program that was set to pay out $10.4 billion to insurers for covering high-risk individuals a year ago could drive up premium costs and create marketplace uncertainty.

The Wall Street Journal reported on Friday that the Centers for Medicare and Medicaid Services (CMS), the agency that oversees the program, is considering the temporary halt of payments to insurers this fall and next fall.

The New Mexico ruling found fault with the formula used by the government to calculate the payments, saying it was "arbitrary and capricious".

"We were disappointed by the court's recent ruling. As a result of this litigation, billions of dollars in risk adjustment payments and collections are now on hold", CMS Administrator Seema Verma said.

Officials said Saturday that the administration is acting because of conflicting rulings in lawsuits filed by some smaller insurers who question whether they're being fairly treated. The CMS said it won't be making transfer payments for the 2017 benefit year totaling $10.4 billion.

The Trump administration's decision to freeze billions in payments to health insurers with plans under Obamacare that cover a higher number of sicker patients could cause health care premiums to rise in 2019.

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"Any action to stop disbursements under the risk adjustment program will significantly increase 2019 premiums for millions of individuals and small-business owners, and could result in far fewer health plan choices", said Justine G. Handelman, a senior vice president of the Blue Cross and Blue Shield Association.

"This decision will have serious consequences for millions of consumers who get their coverage through small businesses or buy coverage on their own".

"When the rules of the game change after the fact - insurers don't necessarily see the federal government as a particularly reliable partner right now", Levitt says. "It moves us back to some extent to the status quo where people with pre-existing conditions found it very hard to get insurance".

Dr. Dave Weldon, president of the Alliance of Health Care Sharing Ministries, discusses why the health care sharing ministry group, known as Samaritan Ministries, could be a good alternative for people who can't find affordable healthcare.

The goal of the payouts was to encourage all insurers to participate in the Obamacare exchanges and enroll all kinds of customers versus only targeting young, healthy people, according to the report.

The suspension of the payments comes amid other efforts by the Trump administration to try to chip away at the landmark health care law. In June, the administration said it wouldn't defend central portions of Obamacare in federal court, claiming that key provisions should be invalidated and that the individual mandate is unconstitutional.


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