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Seema Verma, administrator of Medicare Centers and Medicaid Services, listens at a meeting on health reform. (Jabin Botsford / Washington Post)
The Trump administration has taken another major blow to the Affordable Care Act, disrupting billions of dollars in annual payments required by law to equalize the cost for insurers whose clients need expensive medical services. 19659003] In a rare Saturday afternoon announcement, the Centers for Medicare and Medicaid Services said they would stop collecting and paying money as part of the risk adjustment program. from the ACA. One of three methods incorporated into the 2010 Health Act to help insurance companies protect insurance companies from the ACA's requirement to protect insurance companies. accept all clients for the first time – healthy and sick – without charging more for those in need of substantial care.
Two methods were temporary, but the risk adjustment is permanent. Federal health officials are required every year to calculate which insurers with relatively inexpensive consumers must invest in a fund, and those with more expensive customers owe money. This idea of risk pooling has had significant practical effects: encouraging insurers to participate in the insurance markets that the ACA has created for Americans who can not get affordable health benefits through a employment
. $ 10.4 billion in payments that are due to insurers in the fall for expenses incurred by insurers last year.
CMS, a branch of the Department of Health and Human Services that oversees much of the law, is expected to publish an annual report on the program, but has not released a report due late last month .
The suspension of these payments is Trump 's latest maneuver to undermine the health care law that President Trump has promised since his demolition. A congress led by Republicans last year failed to repeal much of the ACA. The administration has taken steps to dismantle it through executive powers.
Last year, health authorities halved the annual US enrollment period to buy ACA health plans and cut federal funding for advertising by 90 percent. other advocacy efforts to encourage people to sign up. Last October, the president ended another major subsidy to insurers: shared cost reductions, which protected them from the requirement of the law to offer discounts on franchises and d & # 39; other fees to low-income customers. The Department of Labor and HHS have worked to help people and small businesses buy two types of insurance policies that escape the benefits provided by the ACA and some legal protections.
The five-paragraph statement In addition, a calendar released Saturday justified the latest move by badociating it with a legal dispute over the fairness of the risk adjustment formula. The dispute dates back about three years to a new type of nonprofit insurer, known as Consumer Oriented and Operated Plans (co-ops), created by the ACA as alternatives to the companies of Canada. Traditional insurance. Most of the cooperatives found themselves in such a fragile financial situation that they closed their doors, and some survived the lawsuit, alleging that they were unfairly paying contributions to the adjustment fund. risks as larger, more established insurers receive payments.
In two cases, the District Federal Judges of Mbadachusetts and New Mexico drew opposite conclusions. The Mbadachusetts judge ruled the HHS formula right, but that of New Mexico held that it was "arbitrary and capricious". Federal health authorities are demanding that the New Mexico decision be reconsidered.
"The CMS Administrator, Seema Verma, said in a statement:" As a result of this litigation, billions of dollars of risk adjustment payments and recoveries are now suspended.
Two major insurers "Trade groups immediately decried the move."
"Risk adjustment is a mandatory program under federal law," said Scott Serota, president of Blue Cross Blue Shield Association. "Without a quick resolution, this measure will dramatically increase the premiums for 2019 for millions of individuals and small business owners …. This will hurt Americans' access to affordable coverage, especially for those who have need medical care. "
Matt Eyles, president of the US health insurance plans, said the timing of this move could be particularly disruptive., because it's the season during which insurers across the country decide to participate in the ACA's marketplaces for 2019 and, if so, what are the rates to be charged. "This decision. . "This will create more uncertainty in the market and increase premiums for many health plans," said Eyles.
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