CMS announcement regarding ACA insurer payments

[Dtail]

Quote:

Originally Posted by rodi As someone who is on an ACA plan and still in my 50's... I'm definitely going to watch these impacts. I'm hoping the pre-existing condition thing doesn't get blown up.

Big +1

[explanade]

People who buy ACA is a small percentage of the population. And the people who pay out of pocket, without subsidies, is an even smaller portion.

I think before there's drastic change, the bulk of the insured would have to see their coverage deteriorate, namely people who get insurance through work. They comprise like 150 million.

In that market, deductibles and out of pocket costs are going up, in many cases unaffordable for people to meet the deductibles so there are more stories of people going without care, especially prevention care and testing and even people who don't take prescribed drugs.

It maybe be awhile before the bulk of that 150 million cohort sees their coverage deteriorate to the point where tens of millions clamor for change.

There's just as good a chance we revert to the situation before the ACA as there is of the country moving on to some other system.

[samclem]

The ongoing unsolved problem is the increasing cost of the medical care itself. The insurance intermediaries (public or private) consume a relatively small portion of the expenditures, and at least in theory the cost they impose are to some degree offset by cost containment functions they perform, often in their own interests as well as those of the patient (coordination of care, fraud reduction, etc).
Improving the efficiency of providing health/wellness services is where the most important changes must come if any system is to work over the coming decades. Getting the incentives right will be key to that, IMO.

[candrew]

Quote:

Originally Posted by ShokWaveRider Makes a Medicare for all solution more attractive. The money would go direct to the providers instead of the insurance companies. Seems to make a lot of sense.

+1

[MichaelB]

Quote:

Originally Posted by bjorn2bwild To be clear, I did not start this thread. I posted the article to the "ACA Rate increases for 2019" thread, thinking it was relevant based on this quote - “Any action to stop disbursements under the risk adjustment program will significantly increase 2019 premiums for millions of individuals and small-business owners, and could result in far fewer health plan choices,” Sorry about the political entanglement.

No need to apologize, you’ve done nothing wrong. I started the new thread with your post, becasue it merits its own discussion, is relevant, but doesn’t really fit the thread on 2019 price increases, which are very specific. This change in policy hasn’t even been fully announced, and few details are available. In addition, in many cases 2019 have already been submitted to state insurance regulators, so the impact of this announcement is quite uncertain.

It would be nice if folks would keep politics out of the discussion.

[HGTVfan]

CMS has reversed course and is now going to continue to pay a risk adjustment to insurers who accept sicker people.

https://www.politico.com/story/2018/...s-trump-740411

[MichaelB]

Quote:

Originally Posted by HGTVfan CMS has reversed course and is now going to continue to pay a risk adjustment to insurers who accept sicker people. https://www.politico.com/story/2018/...s-trump-740411

Thanks. Here's the CMS announcement https://www.cms.gov/Newsroom/MediaRe...8-07-24-2.html

Quote:

Today, the Centers for Medicare and Medicaid Services (CMS) posted a final rule that reissues, with additional explanation, the risk adjustment methodology that CMS previously established for transfers related to the 2017 benefit year. This important step fills a void created by a federal district court’s vacating of the previously issued methodology, and enables the agency to resume the CMS-operated risk adjustment program in the individual and small group markets. The Patient Protection and Affordable Care Act (PPACA) established a permanent risk adjustment program to provide payments to health insurance issuers that enroll higher-risk populations, such as those with chronic conditions, funded by payments from those that enroll lower-risk populations, thereby reducing incentives for issuers to avoid higher-risk enrollees. “This rule will restore operation of the risk adjustment program, and mitigate some of the uncertainty caused by the New Mexico litigation,” said CMS Administrator Seema Verma. “Issuers that had expressed concerns about having to withdraw from markets or becoming insolvent should be assured by our actions today. Alleviating concerns in the market helps to protect consumer choices.” CMS has determined that taking immediate action to allow for the continued operation of the risk adjustment program is imperative to maintain stability and predictability in the individual and small group health insurance markets. Quick resolution also helps to preserve the significant investment made by states, issuers, and the federal government to stand up the program. This final rule reissues the risk-adjustment methodology previously established for the 2017 benefit year. Since its inception in 2014, the risk adjustment program has faced multiple federal court challenges. On February 28, 2018, the United States District Court for the District of New Mexico issued a decision finding CMS’ use of statewide average premium in the risk adjustment transfer formula governing the 2014-2018 benefit years to be arbitrary and capricious. The court vacated the rule, and remanded it to the agency for further explanation of CMS’ rationale for adopting the statewide average premium. Since this case was filed, CMS has vigorously defended its implementation of the risk adjustment program. CMS has sought relief from the court’s February order, and filed a motion for reconsideration.

[ShokWaveRider]

This is a relief, let us hope it holds.

[GTFan]

Wow, I'm actually shocked at this given last year's cancellation of CSR subsidies (which hurt all the folks who didn't get subsidies, not the insurance companies that were the target).

Guess that upcoming election may have had something to do with it.