Trump administration freezes Obamacare payments, citing court decision

Wednesday, 11 Jul, 2018

"As a result of this litigation, billions of dollars in risk adjustment payments and collections are now on hold", CMS Administrator Seema Verma said.

The risk-adjusted premium pool takes money from healthier patients paying for health care and redistributes it to the less healthy, more needy patients to pay for higher premiums.

The Centers for Medicare and Medicaid Services, which oversees the ACA program, announced Saturday that a federal court ruling prevents CMS from making further collections or payments under the risk adjustment program, including an expected $10.4 billion for the 2017 benefit year.

In the MA case, however, a federal judge upheld the Obamacare formula, the Journal reports.

Dr. Dave Weldon, president of the Alliance of Health Care Sharing Ministries, discusses why the health care sharing ministry group, known as Samaritan Ministries, could be a good alternative for people who can't find affordable healthcare.

"We urge the Trump administration to back off of this unsafe and destabilizing plan, and instead begin working on bipartisan solutions to make coverage more affordable", said Brad Woodhouse, the executive director of Protect Our Care, a progressive group that supports Obamacare. While the administration says it is required to stop payments because of the court decision, insurers say the move could result in higher premiums for millions of individuals and small businesses.

The trade organization representing health insurers says the decision to halt the payments will have major impacts on consumers - especially those who get their coverage through a small business or buy it on their own. 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. According to health insurers, this could drive up premium costs and create health care marketplace uncertainty. Last month the Department of Justice decided not to defend the law in a court challenge in Texas, jeopardizing the part of the law that protects people with pre-existing conditions from being denied coverage, as NPR reported. They assisted 42% of enrollees, the agency said.

"The Trump administration just keeps pushing their destructive repeal-and-sabotage agenda, no matter the cost to the American people", the statement reads.

Insurers criticized the payment freeze, arguing it harms consumers and will cause turmoil for the insurance industry as they move to finalize their 2019 rates. But a month later a federal judge in New Mexico said it was.

The administration's funding for such outreach had already been slashed previous year to well below the $63 million budgeted annually under former President Obama.