Trump administration halts billions of dollars of ACA payments

Trump administration freezes Obamacare payments, citing court decision

Health care insurance customers could be in for some sticker shock over next year's prices now that the Trump administration says it's freezing payments under an "Obamacare" program that protects insurers with sicker patients from financial losses.

The calculated risk adjustment payment for 2017 was $10.4 billion, according to CMS. The risk-adjustment program has been a source of frustration for small insurers and ACA co-ops that claim the formula makes their membership bases look healthier than they are. "As a result of this litigation, billions of dollars in risk adjustment payments and collections are now on hold", CMS Administrator Seema Verma said in a statement.

America's Health Insurance Plans (AHIP), the trade organization representing health insurers, decried the suspension of the payments.

CMS provided a timeline, noting that after the February 28 decision by the New Mexico federal court, it filed a motion for reconsideration, and on June 21 the court held a hearing on it. CMS is waiting for the court's ruling, it said.

Trump tweeted dozens and dozens of times about Obamacare and its demise past year as he pushed the Senate to repeal the law.

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Still, insurers are grappling with changes that the Trump administration and Congress have made to Obamacare for 2019. The agency says the court ruling also prevents it from collecting additional risk-adjustment funds until the issue is resolved. In a March 2018 ruling out of New Mexico, US District Court Judge Thomas Browning that the methodology used by the federal government was "arbitrary and capricious" and remanded it back to the agency, according to Lexis Legal News.

"So much uncertainty put in the market at this point of time is very unnerving", said Ritu Agarwal, senior associate dean of research at the University of Maryland Robert H. Smith School of Business, who follows the health care system.

"An effective risk adjustment program is crucial to the sound operation of a health insurance marketplace in which individuals, families and small businesses with health needs have access to more affordable, high-quality coverage", said Bill Wehrle, Kaiser Permanente vice president of health insurance exchanges, in a statement. The court sent the rules back to the Centers for Medicare and Medicaid Services to rework the formula.

"Republicans are doing a bang up job ensuring they are properly blamed for health care rate hikes this fall", Matt House, a spokesman for Senate Democratic Leader Chuck SchumerCharles (Chuck) Ellis SchumerAn end game on Supreme Court nominations Liberals forget Constitution as Supreme Court battle fires up Anti-Trump protesters sing national anthem outside rally MORE (N.Y.), said in a Monday tweet".

The Blue Cross Blue Shield Association, a federation of 36 Blue Cross and Blue Shield companies nationwide, also expressed disapproval at the move, saying it could create "turmoil" in the market.

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