CMS announcement regarding ACA insurer payments

[bjorn2bwild]

This will be something to watch -

WASHINGTON — The Trump administration said Saturday that it was suspending a program that pays billions of dollars to insurers to stabilize health insurance markets under the Affordable Care Act, a freeze that could increase uncertainty in the markets and drive up premiums this fall.
Many insurers that enroll large numbers of unhealthy people depend on the “risk adjustment” payments, which are intended to reduce the incentives for insurers to seek out healthy consumers and shun those with chronic illnesses and other pre-existing conditions.
“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,” said Justine G. Handelman, a senior vice president of the Blue Cross and Blue Shield Association. “It will undermine Americans’ access to affordable care, particularly for those who need medical care the most.”

https://www.nytimes.com/2018/07/07/us/politics/trump-risk-adjustment-payments-obamacare.html

 

[Rianne]

It's my understanding the affordable care act is law as far as subsidies go. This will drastically hurt those incomes higher than the subsidy allows. The law is solid for pre existing conditions, low incomes, certain medical services as yearly check-ups, cancer screening etc. Correct me if I'm wrong, the law itself is not affected. The way the insurance companies are paid is affected. If the premium goes up, the subsidy goes up for low income people.

 

[explanade]

I heard if they stop those payments and premiums increase, they end up paying out more in subsidies.

So it's not even saving money.

 

[ShokWaveRider]

More incentive to wait another year before collecting SS...…… DW is still on ACA.

 

[aja8888]

Looks like there are two sides to this coin (from the OP's article posting):

.......administration officials said they were caught between two conflicting court rulings. The New Mexico ruling prevents the government from making further collections or payments under the risk adjustment program using the current formula, they said. But, they added, in January a federal district judge in Massachusetts upheld the method used by the government to calculate risk adjustment payments.

While insurers warned of market turmoil if the payments were withheld, Dr. Martin E. Hickey, the founder of New Mexico Health Connections, the company that filed the lawsuit in that state, said the court ruling there would benefit consumers.

“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,” Dr. Hickey said in an interview on Saturday.

“People spin the administration’s decision as trying to do harm, but it’s exactly the opposite,” Dr. Hickey said. “It will allow more companies to get into the insurance market. That will increase competition, and competition will help keep prices down.”

 

[Rianne]

Yes, two sides to the discussion regarding payments, but what about the essentials. Pre existing conditions, cancer screenings would get wiped out or manipulated if HI went back to the Wild West as it was before ACA. I mean for people who lost their insurance or COBRA coverage.

I totally get the concept, look at car insurance. We are mandated to have car insurance. You can buy cheap or expensive, but somehow I understand the coverage so much better. Why can't health insurance companies explain and be truthful about the exact coverage they're offering? The ACA simplified coverage for me. I know exactly what I have to pay with a high deductible plan, what doctors are in network, what is max out of pocket, how much the HI company discounts the procedures and services.

The logistics of ACA were confusing at first but I caught on quickly. I know there is an out of pocket maximum. That gives me comfort. I know if I change plans my pre existing is covered. I'm a simple person. I do not want a HI salesperson to manipulate my coverage and me be put in a position where I could go bankrupt if I get sick!

 

[explanade]

They're trying to get association plans which wouldn't cover all the things that ACA plans would.

So yeah the premiums would be lower but if you tried to file a claim, you probably won't get coverage.

 

[samclem]

If we can keep this thread devoted to the impact of any changes in ACA market stability payments/risk corridor payments, we can probably make a lot of progress here.

 

[joeea]

If we can keep this thread devoted to the impact of any changes in ACA market stability payments/risk corridor payments, we can probably make a lot of progress here.

Little by little the stability of the ACA marketplace is being eroded. This is just one more phase.

“It will undermine Americans’ access to affordable care, particularly for those who need medical care the most.”

Yup. Expect even less affordable plans.

I'm glad I have Medicare in my near future.

 

[VanWinkle]

Little by little the stability of the ACA marketplace is being eroded. This is just one more phase.

“It will undermine Americans’ access to affordable care, particularly for those who need medical care the most.”

Yup. Expect even less affordable plans.

I'm glad I have Medicare in my near future.

"Those that need care the most" were getting it on Medicaid before the ACA existed. All the ACA did was increase the rolls of who "needed it most".
Any plan that allows millionaires to get free coverage is not a plan that can be sustained for more than a few years without huge infusions of money that this country does not have.

I'm also glad to have Medicare in my near future.

 

[ivinsfan]

It's interesting to read all these articles and realize exactly how much the government is pumping out to the insurance companies. Premium subsides, cost sharing for lower income families and now billions in "risk adjustment" payments. Where does it end and much does this all really cost anyway?

To stay on topic there are so many different payments going from citizens and the government to the insurance companies eventually Murphy's law is going to have to kick in. I dont' think even the insurance companies or the government have a clue what the trickle down to the consumer will cost.

 

[VanWinkle]

It's interesting to read all these articles and realize exactly how much the government is pumping out to the insurance companies. Premium subsides, cost sharing for lower income families and now billions in "risk adjustment" payments. Where does it end and much does this all really cost anyway?

To stay on topic there are so many different payments going from citizens and the government to the insurance companies eventually Murphy's law is going to have to kick in. I dont' think even the insurance companies or the government have a clue what the trickle down to the consumer will cost.

+1

 

[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.

 

[gerntz]

Little by little the stability of the ACA marketplace is being eroded. This is just one more phase.

“It will undermine Americans’ access to affordable care, particularly for those who need medical care the most.”.

It's the law that allows the erosion. Nothing else.

 

[gerntz]

It's interesting to read all these articles and realize exactly how much the government is pumping out to the insurance companies.

Those that choose to keep themselves informed don't need articles to realize this.

 

[ivinsfan]

Those that choose to keep themselves informed don't need articles to realize this.

I ponder how much digging is required to obtain the complete picture..but I can assure you, I consider myself to be informed. How many pages is the ACA law again? Did you read the entire thing or use third party info to inform yourself?

In fact I think obfuscation about this is no accident.

 

[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.

 

[ivinsfan]

I'm not going political I'm just saying there are so many different parts of ACA trying to predict the number of insured and their rates is a guessing game.

there is a big articles about this in the Star Trib ...saying the money passes thru the governments hands but in fact is a squaring up within the insurance companies preventing one company from getting hit with a bunch of high costs policy holders because of no more pre existing condition exclusions ..I guess the question is how much does all this cost?

The amount shuffled between the companies nationwide is over 10 billion a year and some companie s say the current formula isn't figured properly.....some companies with actually end up with more money if the formula is thrown out.It's all about "show me the money"

 

[aja8888]

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.

That's been working pretty well for us and all of our 65 year old friends and family for years now. The only insurance element is voluntary insurance coverage for what costs Medicare does not cover. And that's not much in the big picture of Medicare.

 

[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.

 

[Dtail]

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]

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]

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.