Trump administration freezes Obamacare funds

Donald Trump

On Feb. 28, 2018, a federal judge in New Mexico decided that the use of the statewide average premium formula to calculate risk adjustment payments was flawed.

At stake is more than $10 billion in "risk adjustment" payments - a feature of the 2010 health law that requires insurers with healthier consumers to reimburse plans that end up with costlier, sicker patients, so the market balances out. "CMS has asked the court to reconsider its ruling, and hopes for a prompt resolution that allows CMS to prevent more adverse impacts on Americans who receive their insurance in the individual and small group markets", said CMS Administrator Seema Verma.

"We are extremely disappointed that the administration has frozen payment transfers under the Affordable Care Act's (ACA) risk adjustment program, which is created to keep costs down for consumers while meeting the medical needs of those requiring significant care", President and CEO Scott Serota said in a statement.

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"It has caused insurer collapses and market exits that reduced competition".

Martin Hickey, the founder of New Mexico Health Connections, the state's health care co-op and the company that filed the lawsuit, believes the court ruling will reduce the prices and benefit consumers.

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Trump and his team have continued to argue that the individual mandate is unconstitutional and has promised to refuse to defend any parts of Obamacare in court. It's a move that could shake up insurance markets.

"Without a quick resolution to this matter, this action will significantly increase 2019 premiums for millions of individuals and small-business owners and could result in far fewer health plan choices", Scott Serota, president and CEO of The Blue Cross Blue Shield Association, said in a statement. New Mexico's ruling alone isn't enough to freeze payments, unless, he says, it's a "politically motivated" move to further disrupt the ACA. It added that the move comes at a critical time when insurance providers are developing premiums for 2019 and states are reviewing rates.

More broadly, the move contributes to a string of actions from the Trump administration, including the cancellation of other ObamaCare payments a year ago, that have added to insurers' uncertainty and frustration. "And costs for taxpayers will rise as the federal government spends more on premium subsidies", AHIP said in a statement.

The Republican Congress tried to repeal the Affordable Care Act at every turn in 2017 and now they are trying to take away the protection it provides for people with pre-existing conditions. On the same day, Minuteman Health, Inc. filed a similar complaint in district court in MA.

CMS provided a timeline, noting that after the February 28 decision by the New Mexico federal court, it filed a motion for reconsideration, and on June 21 the court held a hearing on it. CMS is waiting for the court's ruling, it said.

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