Trump administration takes another swipe at 'Obamacare'

Desiree Burns
July 13, 2018

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.

She noted it is the latest action by the administration of President Donald J. Trump, which has weakened the landmark law that expanded healthcare for many more Americans.

Even so, enrollment under the health law has remained remarkably steady.

This provision, called "guarantee issue", remains one of the most popular among consumers, according to numerous opinion polls.

But making guaranteed issue work is another story. Many insurers that enroll large numbers of unhealthy people depend on the "risk adjustment" payments, which are meant to reduce the incentives for insurers to seek out healthy consumers and shun those with chronic illnesses and other pre-existing conditions.

In announcing a more than 70 percent funding cut from a year ago, the Centers for Medicare and Medicaid Services said in a notice that the marketplace navigator groups should be able to "stretch their funding further" with less demand for in-person assistance because the marketplace is more familiar to most Americans.

"It's time for the Navigator program to evolve, which is why we are announcing a new direction for the program today", Verma said in a statement.

CORRECTION: A previous version of this story said CareSource was receiving federal money from the risk pool and would have to pay $16 million. But the justification was flimsy - a ruling last February by a judge in New Mexico that the government's method of calculating the payments was flawed.

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Instead, she sold the Bridgehampton home for $8 million in 2014 and bought a $3.1 million property in Sag Harbor. This would mean her children would never receive their share of the money.

CMS said it was "disappointed" by that decision and asked the judge to reconsider, which tends to be faster than the appeals process.

The ambiguity involved in the conflicting New Mexico and MA rulings may mean the suspension of payments will indeed be temporary. The agencies in a statement said that they were seeking legal redress and understanding and will be informing all the involved participants of any bring up-to-date information regarding the current collections or future payments at the right time.

Nonetheless, the timing is problematic. 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.

Technically, the administration has only suspended risk adjustment payments, not permanently ended them. 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.

The cost of any increase in premiums that results from the risk adjustment payments may come from taxpayer dollars.

The suspension of risk adjustment payments won't matter to people who quality for income-based federal subsidies, which rise along with premium costs.

For the past five years, when insurance has been available through ACA marketplaces for people who do not have access to affordable health benefits through a job, federal health officials have started every spring working with navigator groups on plans for the coming enrollment season.

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