Published: Fri, July 13, 2018
Medical | By

The Health Insurers Squawk

The Health Insurers Squawk

But here too the insurers have threatened higher premiums, even as the insurers pocket tax-credit subsidies that increase with premiums.

The Centers for Medicare and Medicaid Services, the federal agency that oversees ACA funding, said in a statement that navigators are inefficient, signing up a fraction of all ACA customers, and unnecessary as the ACA enters its sixth year and the public is increasingly familiar with health insurance. "We believe they overstate the risk that CMS will not make risk adjustment transfers or the move will upend the Affordable Care Act insurance markets".

Officials with CareFirst BlueCross BlueShield, one of two Maryland insurers that sell Affordable Care Act plans, said they need the payments to keep that part of their business afloat. The ACA was implemented four years ago, so knowledge is widespread and the investment needed to educate Americans is likely far lower than before.

The president last fall also issued an executive order to try to make it easier for individuals and small businesses to buy health plans that cost less than ACA coverage because they cover fewer medical services and bypass the law's rules meant to protect people from old insurance practices in which companies had charged higher prices to women, older people, and those with preexisting medical conditions.

"The program does not cost taxpayers any money and has worked effectively to help balance the cost of caring for those with significant health needs by ensuring that health plans are able to enroll all consumers, regardless of their health status", Serota said in a statement. The judge tossed out the formula used to calculate payments, finding that it was flawed.

"It's time for the navigator program to evolve, which is why we are announcing a new direction for the program today".


CMS is freezing $10.4 billion in Affordable Care Act risk-adjusted payments, created to stabilize the insurance market by redistributing money to insurers with higher-cost members.

The administration argued in its announcement that its hands were tied by conflicting court rulings in New Mexico and MA. About 20 million Americans have received health insurance coverage through the program. 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.

Navigator groups that have helped people sign up for health insurance since Obamacare coverage began in 2014 said the funding cuts will be hard to absorb. The insurers have requested average rate increases for 2019 that range from 18.5 percent to 91.4 percent, depending on the type of plan.

Technically, the administration has only suspended risk adjustment payments, not permanently ended them. "It is important to keep in mind that the original risk adjustment payments are budget-neutral such that for some insurers to win, other insurers have to lose".

Navigators say they don't get credit for all the consumers they help guide through the process but don't actually sign up. This year they helped sign up almost 520,000 people for health insurance sold through the ACA exchange in North Carolina.

Like this: