Medical

Obamacare 'navigator' program cut further by Trump administration

Obamacare 'navigator' program cut further by Trump administration

On Saturday, the administration said it would suspend a program that was set to pay out $10.4 billion to insurers for covering high-risk individuals under Obamacare past year, saying that a recent federal court ruling prevents the money from being disbursed.

Trump administrators suspended the payments over a February ruling by a federal district court in New Mexico, according to the reports.

At stake are billions in payments to insurers with sicker customers.

The idea behind the program is to remove the financial incentive for insurers to "cherry pick" healthier customers.

The payments were created to stop insurers from losing money on very sick patients, who cost the most to treat. The program is based on a patient's risk score, which is determined by a person's demographic information and health condition. The court sent the rules back to the Centers for Medicare and Medicaid Services to rework the formula.

"Enrollment data from previous years show that Navigators failed to enroll a meaningful amount of people", CMS said. "The decision will have serious consequences for millions of consumers who get their coverage through small businesses or buy coverage on their own", the group said.

"Without a quick resolution to this matter, this action will significantly increase 2019 premiums for millions of individuals and small business owners and could result in far fewer health plan choices".




But Senator Ron Wyden, the ranking Democrat on the Senate Finance Committee, said encouraging navigators to promote plans that don't comply with the ACA is "federally funded fraud: paying groups to sell unsuspecting Americans on junk plans that allow insurance companies to deny care on a whim and charge whatever they want is nothing but a scam". Legacy insurers that have a wealth of patient data may have a leg up on coding.

The Congressionally mandated risk adjustment program of the Affordable Care Act redistributes funds from plans with lower-risk enrollees to plans with higher-risk enrollees, helping to ensure that sicker individuals can receive coverage by sharing the cost of covering them.

CMS cites the late February court ruling in deciding to place a freeze on the $10.4 billion which it collected past year, and which ordinarily would be dispersed among high-risk insurers.

The CMS statement said the agency will "provide additional guidance shortly on how it will handle other issues relating to risk adjustment payments". "New Yorkers aren't fooled".

A federal court in MA upheld the same allocation formula in January. Obamacare's mandated coverage of many items that most people don't need is the real problem.

While some may say this means no government money is involved, this ignores the concern expressed in the New Mexico court decision.

Rumors that the Trump administration would freeze payments were circulating late last week.