Trump adds more confusion to Obamacare

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On Saturday the administration announced it was suspending a risk adjustment program.

To fully understand the administration's latest move, a little history is in order. At the end of the year, President Trump signed the tax reform bill into law, which repealed the individual mandate imposing a fine on those who don't buy health insurance; that will go into effect in 2019. That's why Obamacare included several provisions to help insurers cover the costs of the sickest patients - among them, the risk adjustment program. The nonprofit insurer sued the government in 2016 claiming the risk adjustment program unfairly penalized smaller insurers.

The program's freeze comes after a federal judge in New Mexico ruled that the formula it used to redistribute the money was flawed. Why the administration waited so long to take action rather than immediately respond to the decision with a justification of its payment formula remains a mystery.

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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 fund would be separate from the federal risk adjustment payments and could allow the insurers to reduce their requested rate increases by as much as 30 percent. And the number of insurers planning to offer policies through the Obamacare exchanges has increased. The mandate was created to stabilize the health insurance market by encouraging younger and healthier Americans to sign up for insurance, and the repeal could consequently have the opposite effect. There could have been a "substantive and thoughtful conversation" about what more needs to be done, she said.

Although small insurance plans and some cooperatives complained that Obamacare risk adjustment skewed in favor of bigger, entrenched players, almost all insurers condemned the CMS ruling to freeze the risk adjustments. Block grants to the states would be based on ACA subsidies and the cost of Medicaid expansion "as of a fixed date", i.e., frozen, putting "federal spending on real budget", according to the plan.

"We were disappointed by the court's recent ruling", CMS Administrator Seema Verma said in a statement.

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Whatever happens with the risk adjustment payments, it looks as if many exchange consumers will be left to figure out their options for 2019 on their own.

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. That's because on Tuesday, CMS announced another major cutback to its health insurance counseling program.

"Given the continued attacks on healthcare, including federal rules allowing the resurgence of low-priced, junk health insurance plans, such as "association health plans" and "short-term plans", consumers looking for good, comprehensive coverage could be easily confused", Frederick Isasi, executive director of Families USA, a Democrat-leaning healthcare advocacy organization, told CNN.

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Photo by Associated Press /Times Free Press.