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People familiar with the plan told the WSJ that the Centers for Medicare and Medicaid Services (CMS), the agency that oversees the program, could at least temporarily halt payments to insurers this fall and the next year. next autumn. These payments would have resulted respectively from the insurers' activities in 2017 and 2018.
According to the sources, this decision stems from a recent Federal Court decision that concluded that the formula for calculating payments of interest is the same. risk adjustment was wrong. In March 2018, US District Court Judge Thomas Browning said the methodology used by the federal government was "arbitrary and capricious" and referred to the agency, according to Lexis Legal News.
respond immediately to a request for comment from CNN and the agency has publicly announced no suspension of payments.
Risk adjustment is a key aspect of market stabilization under the ACA, also known as Obamacare. The program transfers funding from lower risk plans to higher risk plans in order to standardize the market and "encourage insurers to be competitive based on value and value." efficiency of their diets rather than attracting healthier affiliates ". Kaiser Family Foundation
The movement reported by the WSJ follows other efforts by the Trump administration to try to choke off the historic health care law. In June, the administration said it would not defend Obamacare's central parties in federal courts, saying the key provisions should be invalidated and that the individual mandate is unconstitutional. In October 2017, the White House announced that it would end the Obamacare cost-sharing payments that helped low-income people pay for health care.
The WSJ report also comes from the fact that insurers appeared to be going back to the ACA. Insurers were entering or returning in at least a dozen states in 2019, while others were expanding their presence in the states where they operate.
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