The Centers for Medicare and Medicaid Services (CMS), the body that oversees the program, cited a recent Federal Court decision that concluded that the formula for calculating risk adjustment payments was flawed. In a March 2018 ruling in New Mexico, US District Court Judge Thomas Browning stated that the methodology used by the federal government was arbitrary and capricious and sent the case back to court. agency, according to Lexis Legal News. disappointed by the recent court decision, "said CMS administrator Seema Verma in a statement. As a result of this litigation, billions of dollars of risk adjustment payments and recoveries are now suspended. CMS has asked the court to reconsider its decision, and hopes for a swift resolution that allows CMS to avoid more negative impacts on Americans who receive their insurance on individual and small group markets. "
The Wall Street Journal Was The First The expected payments insurers this fall, based on their business in 2017, amounted to $ 10.4 billion.
Insurance Plans American health (AHIP), the commercial organization representing the health insurers, have decried the suspension of payments
"We are very discouraged by the new market disruption caused by the decision to freeze the payments of "Risk adjustment," said the group in a statement on Saturday, their coverage by small businesses or buy a cover on their own.This will create greater uncertainty in the market and will increase premiums for many health plans will increase the burden on small businesses and consumers and reduce coverage options Taxpayer costs will increase as the federal government will spend more on premiums.
The Blue Cross Blue Shield Association, a federation of 36 companies from Blue Cross and Blue Shield nationwide, also expressed its disapproval. "We are extremely disappointed that the administration froze payment transfers under the risk-adjustment program of the Affordable Care Act (ACA), which is designed to keep costs for consumers all the time. meeting the medical needs of these President and CEO, Scott Serota, said in a statement: "This measure will significantly increase the premiums of 2019 for millions of individuals and small business owners and could result in much less choice of health plans.This will jeopardize Americans' access to affordable coverage, especially those who are most in need of medical care. "
Risk adjustment is a key aspect of stabilization market under the ACA, also known as Obamacare.According to the Kaiser Family Foundation, the risk would be greater for people at high risk, so a market and "encourage insurers to compete based on the value and effectiveness of their plans rather than attracting healthier people". 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 in October 2017, the White House has announced that it would end the cost-sharing payments of Obamacare that helped low-income people pay for healing.
This also comes at a time when insurers seemed to be coming back to 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.
Still, insurers are struggling with the changes that the Trump administration and Congress have made to Obamacare for 2019. These include the elimination of the individual mandate penalty and the l & # 39; widening the availability of two alternatives to the Affordable Care Act.
These moves prompt some insurers to claim premium increases for 2019 in double-digit numbers.
CNN's Ariane de Vogue and Kevin Liptak contributed to this report.
[ad_2]
Source link
