Trump Administration Cuts Funding For Obamacare Navigator Program

Trump Administration Cuts Funding For Obamacare Navigator Program

Scott Serota, president of the Blue Cross nationwide association, said insurers "are extremely disappointed that the administration has frozen payment transfers under the Affordable Care Act's (ACA) risk adjustment program, which is created to keep costs down for consumers while meeting the medical needs of those requiring significant care".

CareSource, which will offer insurance in 79 of Indiana's 92 counties in 2019, would have gone from being a net receiver of money from the pool to paying about $16 million a year to other insurers - that is, until the freeze went into effect.

To fully understand the administration's latest move, a little history is in order. The new position was outlined a week earlier in a legal brief the Justice Department filed in a Texas case challenging the health law.

But despite President Donald Trump's disdain for "Obamacare", enrollment for subsidized private coverage has been fairly steady, with about 10 million people now signed up.

But making guaranteed issue work is another story. That's bad news for the chronically ill, the disabled, the elderly and all others whose health care costs can run considerably higher than average.

The agency once again defended the decrease by saying that navigators, which usually hail from non-profit and community organizations, are not effective. Another federal judge upheld the risk adjustment formula in a separate case filed in MA.

CMS said it was "disappointed" by that decision and asked the judge to reconsider, which tends to be faster than the appeals process. The payments also were meant to try to prevent insurers from cherry-picking healthier patients to keep costs down.

The ambiguity involved in the conflicting New Mexico and MA rulings may mean the suspension of payments will indeed be temporary. "There was initial panic after the announcement, but the technical problems can be worked out".

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A professor who follows Obamacare said it is unclear if the payments' suspension will result in higher premiums.

Nonetheless, the timing is problematic. This introduces uncertainty into the ACA markets just as insurers are deciding next year's rates.

"Without this program, insurers might have taken on less risk in the market, especially in rural counties", said Mike Kreidler, Washington state's insurance commissioner. "This comes at a time when the market was looking really strong for 2019, and insurers were coming off a very profitable year". 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.

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.

The reduction - the second round of cuts that began last summer - will shrink the federal money devoted to the groups, known as navigators, from $36.8 million to $10 million for the enrollment period that starts in November.

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.

These plans, however, aren't required to have the same consumer protections as ACA policies.

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