Just as more insurers and consumers were entering the ACA individual market and things seemed to be stabilizing, the Trump administration struck a new blow against the health-care sector over the weekend, cutting off the multi-billion dollar risk adjustment payments that compensate insurers for taking on sicker and more expensive patients. Having a risk adjustment program factors into these calculations.
It also said last year's cuts had minimal impact, as year-over-year enrollment dipped slightly, to 11.8 million from 12.2 million, and that navigators enrolled less than 1 percent of HealthCare.gov customers overall.
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.
This follows a reduction announced by the CMS last August from $62.5 million, along with an even bigger cut to advertising for enrollment, and represents the latest in a series of moves to weaken the ACA by the administration of President Donald Trump. But the Trump administration is hanging its decision to withhold subsidies to insurers on court decisions from New Mexico and MA which say the way those payments are handed out is too vague.
Navigators are usually members of nonprofit and community organizations.
CORRECTION: A previous version of this story said CareSource was receiving federal money from the risk pool and would have to pay $16 million.
Insurance companies are setting their rates now for the ACA's November enrollment period, so the loss of risk adjustment payments is sure to drive up premiums regardless of whether the payments are resumed at some future point.
"Longer-term, I think that the administration's walk-back of risk-adjustment payments penalizes those payers that did, in fact, attempt to enroll participants without bias to health status, and unfortunately it also rewards those payers that for whatever reason made a decision to play it that much safer and do their best to recruit healthy individuals", Abrams says.
The most radical plan drafted by congressional Republicans last year-known as the Graham-Cassidy bill after two of its authors, Lindsey Graham (South Carolina) and Bill Cassidy (Louisiana)-would basically eliminate the ACA's private insurance marketplaces as well as Medicaid expansion, replacing them with lower-funded state block grants with few strings attached.
If you're been buying insurance through the Affordable Care Act exchanges, here's more news you need to know. "We've been sending people to navigators", Israel said.
"Let ObamaCare implode, then deal", Trump tweeted on July 28, 2017.
Navigators applying for funding will also be encouraged to show how they will educate people about the newly expanded alternatives to Obamacare, such as association health plans and short-term plans. The Kaiser Family Foundation estimates that 27 percent of people under the age of 65 have what could be considered a pre-existing condition. "In general, when there's uncertainty in the market, insurers will cushion themselves however they can", she said. They also help consumers file appeals with insurers.
Kaiser Health News (KHN) is a national health policy news service.