Health Care Primer: The Sabotage And Retaliation Edition

Report: WH Suspends $10.4B in Obamacare Insurer Payments

The payments insurers expected this fall, based on their 2017 business, amounted to $10.4 billion. As a result of this litigation, billions of dollars in risk adjustment payments and collections are now on hold.

The Affordable Care Act's (ACA) "risk adjustment" program is meant to incentivize health insurers to cover individuals with pre-existing and chronic conditions by collecting money from insurers with relatively healthy enrollees to offset the costs of other insurers with sicker ones, according to Reuters.

The suspension of the payments comes amid other efforts by the Trump administration to try to chip away at the landmark health care law.

Adam "Pacman" Jones Attacked By Employee At Airport, Suspect Arrested
Most recently, Jones pleaded guilty to obstructing police following a January 2017 altercation in downtown Cincinnati. The Cincinnati Bengals opted not to pickup Jones' option for the 2018 season in March making him a free agent.


Chad Terhune, a senior correspondent at California Healthline and Kaiser Health News, discussed the latest move by the Trump administration and the potential impact in California with A Martinez, host of the "Take Two" show on Southern California Public Radio. The left is complaining that HHS halted the payments too casually, but on all the evidence the Trump Administration is trying to abide by the ruling while the courts resolve the dispute. "That will increase competition, and competition will help keep prices down". "It will create more market uncertainty and increase premiums for many health plans-putting a heavier burden on small businesses and consumers, and reducing coverage options".

"We are very discouraged by the new market disruption brought about by the decision to freeze risk adjustment payments", the group said in a statement Saturday.

Similarly, previous year the Trump administration ended Obamacare's cost-sharing reduction payments to health insurers. The Department of Health and Human Services is finishing another rule that will broaden the use of short-term insurance plans, originally intended as a brief bridge for people between jobs.

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But Senator Ron Wyden, the ranking Democrat on the Senate Finance Committee, said encouraging navigators to promote plans that don't comply with the ACA is "federally funded fraud: paying groups to sell unsuspecting Americans on junk plans that allow insurance companies to deny care on a whim and charge whatever they want is nothing but a scam".

The move should not have been unexpected given the administration's disdain for other provisions of the Affordable Care Act (ACA), leading to the elimination of other key taxpayer-funded subsidies and the outright eradication of the individual mandate through this past winter's tax cut legislation. The agency said it will release additional guidance for insurers on issues related to the risk-adjustment program, including appeals and how this will affect medical loss ratios. On the same day, Minuteman Health, Inc. filed a similar complaint in district court in MA. But another district court in MA upheld the formula.

Trump administrators suspended the payments over a February ruling by a federal district court in New Mexico, according to the reports.

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