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The Centers for Medicare and Medicaid Services (CMS) will be offering $10 million in funding this year to groups that will help navigate 2019 enrollment for the Affordable Care Act, CMS said to a statement Tuesday.
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 enrollees.
Over the weekend arrived some fresh political fury that the Trump Administration is trying to sabotage ObamaCare by suspending something called "risk adjustment" payments. After three years, two programs expired, with only the risk adjustment program permanent as stipulated by the law. The Trump administration also is seeking to expand the use of short-term health insurance plans that are often less expensive but don't have the same consumer protections as exchange plans.
Ceci Connolly, who runs the Alliance of Community Health Plans, said the administration could do more to ensure the payments are quickly made, such as issuing the interim final rule, or pursuing other legal avenues. "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.
Speaking for the navigators, Fred Ammons, who supervises the Insure Georgia organization, said: "This is a huge cut to navigator programs across the country".
On Saturday, the administration said it would suspend a program that was set to pay out $10.4 billion to insurers for covering high-risk individuals under Obamacare previous year, saying that a recent federal court ruling prevents the money from being disbursed.
The funding cuts follow CMS's announcement that it would no longer pay subsidize insurers who enroll large numbers of unhealthy people, a move that insurers and ACA advocates said would drive up premiums.
Citing two conflicting federal court cases on the use of statewide average premiums in its decision, CMS said it can not collect or redistribute funds for risk-adjusted payments.
More than 20 million people have coverage through former President Barack Obama's law. The Republican Congress failed to repeal it, so the Trump administration has redoubled its efforts to gut it. A spokeswoman for ConnectiCare said the insurer is "monitoring developments" related to risk adjustment payments and plans to file its 2019 small group and individual plan rates next week.
Payments and collections of risk adjustment payments and charges were scheduled to begin in August. Rate filings by CT health insurers for 2019 are due next week.
Technically, the administration has only suspended risk adjustment payments, not permanently ended them.
Insurers were required to meet a June deadline to say in which in counties they'll sell insurance, as well as which kind of plans - so those are locked in, pending a state review.
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