Indiana Insurers Impacted By Trump Administration ACA Payments Freeze

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"For the insurers that did stick around in the individual market, 2018 is shaping up to be a very profitable year", said Cynthia Cox, director for the Program for the Study of Health Reform and Private Insurance at the Kaiser Family Foundation. It discourages companies from trying to save money by cherry-picking the healthiest people and kicking others to the curb. "It enables the country to move away from a market where plans compete to avoid covering or charge more to people with preexisting health conditions, to one where competition is based on quality, affordable care for everyone". About $10.4 billion was slated to be transferred a year ago.

The Centers for Medicare and Medicaid Services announced that it would suspend $10.4 billion in risk adjustment payments, which are created to compensate insurers that enroll sick, expensive patients.

It's a reversal from past year, when insurers exited some states as losses mounted and President Donald Trump vowed to dismantle the program.

The moves have been criticized as an attempt by Trump to dismantle the ACA, one of Obama's largest legislative achievements.

There has been no demonstrable outrage from leading Democrats on Trump's intensifying campaign to transform Medicaid into a cut-rate voucher program or other aspects of the administration's crusade against the poor and dismantling of what remains of the social safety net.

But multiple insurers have issued statements in recent days saying the decision will likely force some companies to raise rates.

The cost of any increase in premiums that results from the risk adjustment payments may come from taxpayer dollars.

Sen. Ron Wyden of OR, the ranking Democrat on the Senate Finance Committee, said in a statement that urging navigators to promote non-ACA plans amounts to "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 nonprofit insurer sued the government in 2016 claiming the risk adjustment program unfairly penalized smaller insurers.

The Trump administration also issued new rules to try to make it easier for individuals and small businesses to buy health plans that cost less than ACA coverage because they cover fewer medical services.

Insurance Commissioner Al Redmer Jr. said that as of now he doesn't expect the latest decision to interrupt the state's rate-setting process.

Since President Trump took office, his administration has waged an all-out attack on Americans with pre-existing conditions.

"Without this program, insurers might have taken on less risk in the market, especially in rural counties", said Mike Kreidler, Washington state's insurance commissioner. Her insurer, Oscar, is boosting rates again for 2019, and Williams is slated to see an increase to $518.33 for a low-level bronze plan.

He added that it's unclear if the New Mexico ruling - and the suspension - will even apply to 2019 payments or be confined to previous years. "In general, when there's uncertainty in the market, insurers will cushion themselves however they can", she said.

The payments can be controversial, Dai said. Some companies that had expected hundreds of millions of dollars in risk-adjustment payments fear the funds may fall through, while others that had expected to owe hundreds of millions wonder if they may be off the hook. In Maryland, Kaiser usually ends up paying CareFirst.

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