The new reduction of help for navigators, announced late Tuesday afternoon by the Centers for Medicare and Medicaid Services, fits within a pattern of moves by the administration to weaken the sweeping health-care law that President Trump has vowed to demolish. The White House supported two attempts in Congress a year ago to repeal the program, which insures about 20 million Americans.
In its announcement, CMS said the private sector is more cost-effective, so people looking for health coverage should be encouraged to go to insurance agents and brokers (who may receive a commission, unlike navigators).
Because the Affordable Care Act requires insurers to accept all people regardless of their medical history or preexisting conditions, architects of the law created the risk-adjustment program to prevent insurance companies from cherry-picking the healthiest people. To do that, the government collects money from health insurers with enrollees who were healthier and as a result "cost less to insure".
Levitt says the administration's announcement was "a little perplexing", given that the legal fight over the conflicting rulings in New Mexico and MA is still ongoing.
"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.
CMS plans to appeal the court's ruling, as the U.S. District Court for the District of MA ruled to uphold the payments. "As a result of this litigation, billions of dollars in risk adjustment payments and collections are now on hold", CMS administrator Seema Verma reportedly said in a statement. "It will allow more companies to get into the insurance market".
"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. Last year, the administration halted important subsidies for insurers.
The court's ruling bars the agency from collecting or making payments under the current methodology, which uses a statewide average premium, said CMS, which is part of the Department of Health and Human Services.
But CareFirst and Kaiser could ask to adjust their rates higher given the Trump administration's decision.
Many Trump followers often cheer cuts to Obamacare, not knowing that the Affordable Care Act and Obamacare are one in the same.
CMS said in a statement that the funds were being cut because people are more familiar with the exchange program, and that the programs enrolled less than 1% of participants past year.