Did you know that 80-95 percent of carnivores are solitary and hunt alone? Many individual employees and even business owners are out there still buying individual (and heavily subsidized) health insurance plans from the state-run exchanges. But some new moves out of Washington are going to make the GROUP market far more attractive for just about everyone in the coming years.
Recently, Seema Verma, administrator for the federal Centers for Medicare & Medicaid Services, said she was suspending a $10 billion program that helps stabilize the insurance markets created under the Affordable Care Act (ACA). She said the “risk-adjustment” payments and collections had to be halted in response to a New Mexico court ruling in February that said elements of the program were flawed. The risk-adjustment program doesn’t involve taxpayer money. Instead, the federal government collects money from some insurers that enrolled healthier patients and then transfers money to other insurers who had sicker enrollees. Because the Affordable Care Act requires insurers to accept all people regardless of their medical history or preexisting conditions, architects of the law created the risk-adjustment program to prevent insurance companies from cherry-picking the healthiest people.
Make no mistake that this move will really hurt the insurers in the exchanges. And it’s also bad for individuals trying to buy coverage—once again demonstrating that hunting in groups (via the group health insurance market) is going to be a better decision. If your company doesn’t have a group plan, give my team of employee benefits and health insurance experts a call and we can explore all of your options to help you rule your world!
Health Insurers Struggle With Sudden Freeze On ACA Payouts
UPDATE — 7/25/18 — Administration Restores ACA Risk Adjustment Program.
The New York Times reports that, “in an abrupt reversal,” Centers for Medicare and Medicaid Services Administrator Seema Verma issued a new rule restoring the Affordable Care Act’s risk adjustment program, which “pays billions of dollars to insurers to stabilize health insurance markets.” The Administration said, in the Times’ words, that if the program remained suspended, “health plans could become insolvent or withdraw from the market, causing chaos for consumers,” which the Times casts as “essentially” accepting “the arguments of critics, including consumer groups, health insurance companies and Democrats in Congress.” Due to fears they would be “blamed in the midterm elections this year for even higher premiums,” Republicans in Congress advocated restoring the payments.