The decision to halt important Obamacare payments leaves only two likely explanations: incompetence or sabotage.»
As with so many curiously unwise decisions the Trump administration makes, this month’s announcement that it would abruptly halt important Obamacare payments leaves only two likely explanations: incompetence or sabotage.
The Centers for Medicare and Medicaid Services (CMS) stunned the health-care world on July 7, revealing that it would stop collecting and paying out money under the Affordable Care Act’s riskadjustment program. The program helps level out costs among insurers participating in Obamacare marketplaces. Those with inordinately healthy — and inexpensive — customers pay to compensate those with unusually sick — and costly — customers. Without such a program, insurance companies would compete to attract only healthy customers by narrowing benefits and finding other ways to discriminate against people who need care. Insurers who were unsuccessful in deterring sick people from signing up would have to raise premiums, leading to the loss of healthier customers and a downward financial spiral. With the program in place, on the other hand, the insurers in a given market are part of a big, effective insurance pool whose risks are spread across all.
This is Insurance Economics 101, and the concept is not particularly controversial. Yet some smaller players in Obamacare markets objected to the way the federal government implemented the program, complaining that the formulas made them pay too much. A federal judge in Boston rebuffed the complaints. But another federal judge in New Mexico ruled CMS had not provided adequate justification for one element of the system’s design, and enjoined the collection and distribution of riskadjustment funds. This unreasonable ruling is unlikely to stand. Yet CMS insisted it was left with no choice but to halt risk-adjustment payments nationwide.
This is false. It took legal experts such as the University of Michigan’s Nicholas Bagley no time to point out that the administration could have immediately filed an appeal and sought a stay of the ruling in the meantime. Or the administration could have quickly introduced an interim final rule addressing the judge’s criticisms that would have applied immediately. Or the administration could have halted payments only in New Mexico. It chose instead to cause maximum disruption.
Fortunately, the disruption should be temporary. Next year’s risk-adjustment rules provide the justifications for the system’s design that the New Mexico judge complained previous iterations did not, so they will be more resistant to legal challenge. Yet that will not change the damage occurring now. The administration still appears poised to punish insurers by withholding billions in funds they reasonably expected to receive — and for nothing more than partnering in good faith with the federal government to provide health insurance to vulnerable people.
As when the Trump administration declined to defend Obamcare’s insurance regulations in court, this is another case of the president and his team shirking their governing responsibilities. CMS officials should end the disruption immediately.