The Trump administration said Saturday that it is temporarily halting billions of dollars of payments created to help insurers meet the Affordable Care Act requirement that they provide coverage regardless of whether a person is healthy or sick.
"Enrollment data from previous years show that Navigators failed to enroll a meaningful amount of people", CMS said.
But supporters of the ACA criticized the CMS announcement as the latest move by the Trump administration to undermine Obamacare. The program transfers funding from plans with lower-risk enrollees to higher-risk ones in an effort to even out the market and "encourage insurers to compete based on the value and efficiency of their plans rather than by attracting healthier enrollees", according to the Kaiser Family Foundation. No taxpayer subsidies are involved. The permanent program was meant to reduce the incentive for health insurers to cherry-pick healthy members.
America's Health Insurance Plans (AHIP), the trade organization representing health insurers, decried the suspension of the payments.
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Critics said it was just the latest example of the Trump administration undermining the ACA and harming consumers who purchase individual policies.
The Center for Medicare and Medicaid Services (CMS) has suspended payments to health insurers with a large number of sick Obamacare clients.
Trump administrators suspended the payments over a February ruling by a federal district court in New Mexico, according to the reports.
Some health care experts, however, believe that risk adjustment has caused more damage than good and needs urgent fixing.
Insurance companies responded quickly on Saturday with their disapproval.
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Health insurers and Covered California officials are facing another curveball from the Trump administration on the Affordable Care Act that could rattle the insurance market. Obamacare's mandated coverage of many items that most people don't need is the real problem.
Serota noted that the payments are required by law, and said he believes the administration has the legal authority to continue making them despite the court cases.
"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", Verma said. The White House supported two attempts in Congress past year to repeal the program, which insures about 20 million Americans.
The pro-ACA group Protect Our Care issued a statement from its executive director, Brad Woodhouse, Saturday after the administration announced its decision regarding risk penalty payments, characterizing the move as further chipping away at the Affordable Care Act.
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