Trump Administration Cuts Funding For Obamacare Navigator Program


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The Centers for Medicare & Medicaid Services announced over the weekend that it was freezing billions of dollars in so-called risk adjustment payments for plans under the Affordable Care Act, also known as Obamacare, because of a court decision earlier this year that deemed the formula for determining these payments unlawful.

Officials with Kaiser Permanente, the state's other insurer with Affordable Care Act plans, have raised concerns about the risk adjustment program but disagreed with the suspension of the payments. They assisted 42% of enrollees, the agency said.

Frank Pallone called the cuts more "sabotage" from the administration.

The issue is expected to be resolved by the end of the year and risk adjustment transfers will be completed "on time or with only minimal delay", she said.

Insurers are frustrated by the decision to halt the payments, with America's Health Insurance Plans warning of "serious consequences for millions of consumers", while Blue Cross Blue Shield Association CEO Scott Serota said the decision will "significantly increase 2019 premiums". "This decision reflects CMS' commitment to put federal dollars for the Federally-facilitated Exchanges to their most cost effective use in order to better support consumers through the enrollment process". "ORCRP001017-topic.html" class="local_link" >Anthem Inc. and Cigna Corp., referred to the AHIP statement when asked about the impact of the federal payment interruption. The funding will also be provided to each organization based on their success levels for enrollment, a measure CMS said would "ensure accountability within the program and avoid rewarding grantees that have failed to meet performance measures". The announcement comes in the midst of the annual rate-filing period when insurers announce their estimated premium prices and plans for coverage to state regulators.

The administration argued in its announcement that its hands were tied by conflicting court rulings in New Mexico and MA. The mandate requires people without insurance from their employer or a government program to obtain health coverage or pay a penalty. The Maryland Insurance Administration has a hearing scheduled for July 31.

Every action the Trump administration has taken on Obamacare suggests that's their goal.

Technically, the administration has only suspended risk adjustment payments, not permanently ended them. "This comes at a time when the market was looking really strong for 2019, and insurers were coming off a very profitable year". The other two methods were temporary, but risk adjustment is permanent.

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".