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Trump Administration Aims to Steer People Toward Junk Health Plans Over Obamacare

11 July 2018, 06:27 | Rodolfo Wallace

Trump Administration Aims to Steer People Toward Junk Health Plans Over Obamacare

President Donald Trump speaks about health care from the White House in Washington. The Trump administration says it’s freezing payments under an Obamacare program that protects insurers with sicker patients

The Trump administration has taken an axe to the Affordable Care Act, suspending a program that was set to pay $10.4 billion to insurers for covering high-risk individuals previous year.

CMS was referring to a February ruling from a federal court in New Mexico that invalidated the risk adjustment formula, and a January ruling from a federal court in MA that upheld it.

At stake are billions in payments to insurers with sicker customers.

Under the risk adjustment program, insurers with healthier patients pay those with sicker patients. The government collects the money from health insurers with relatively healthy enrollees, who cost less to insure.

The announcement was made by Seema Verma, the administrator of the Centers for Medicare and Medicaid Services, and was precipitated by a New Mexico court ruling that suggested the calculations for the risk-adjusted premiums were flawed even despite a MA ruling that validated them. The court sent the rules back to the Centers for Medicare and Medicaid Services to rework the formula.

The Trump administration's move "will significantly increase 2019 premiums for millions of individuals and small business owners and could result in far fewer health plan choices", association president Scott Serota said in a statement.

Insurance is normally based on risk, with premiums costing more for clients who are expected to require more healthcare services.

The Trump administration is halting billions of dollars in payments required under the ACA, citing a district court decision in New Mexico from earlier this year. Legacy insurers that have a wealth of patient data may have a leg up on coding.

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The Trump administration is cutting most of the funds previously provided to groups that help people get health insurance under the Affordable Care Act and will push them to promote plans lacking the law's benefits and protections, a government agency said on Tuesday.

The administration argued in its announcement that its hands were tied by conflicting court rulings in New Mexico and MA.

The CMS statement said the agency will "provide additional guidance shortly on how it will handle other issues relating to risk adjustment payments".

CMS plans to appeal the court's ruling, as the U.S. District Court for the District of MA ruled to uphold the payments.

Insurance companies responded quickly on Saturday with their disapproval. Following the decision, CMS asked the court to reconsider its ruling.

Democrats say that the cuts are more evidence of Trump officials sabotaging the health law.

"The risk adjustment formula was extremely biased in favor of large, established insurers and discriminated against new and small insurers, including co-ops like ours", Hickey told The New York Times on July 7.



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