The Trump administration took another step Wednesday toward deregulating federal insurance exchanges created under the Affordable Care Act.
For coverage in 2018, consumers can buy an ACA-approved plan directly from a broker or an insurer’s website instead of having to go through HealthCare.gov, the CMS announced. The news comes just two days after small businesses were given permission to skip the federal marketplace to sign their employees up for SHOP coverage.
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The Trump administration won’t penalize insurers for failing to verify the number of severely ill patients they’ve enrolled through the insurance exchanges. The Affordable Care Act mandated that third-party auditors and the Department of Health and Human Services validate that plans receiving risk-adjustment payments do indeed have sicker patients. However, HHS has struggled to get the program off the ground due, in part, to technical woes. Although HHS has been collecting audit data from the plans, it hasn’t held them accountable for discrepancies in their sick patient volumes.
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With time running out to set insurance prices and uncertainty surrounding whether the Trump administration will continue funding cost-sharing subsidies on the ACA exchanges, several states are giving health insurers a little more wiggle room to file 2018 rates. State insurance regulators hope an extra few weeks to price plans will be enough to ease the insurance industry’s jitters created by efforts to repeal and replace the ACA and keep insurers from bailing on the exchanges. Colorado, New Hampshire, Oregon and Kentucky have extended deadlines for insurers to submit rates for 2018 ACA health plans.
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More insurance companies around the country are refusing to pay brokers commissions on higher-tier exchange plans or special enrollment sales as the companies face financial losses on the federal marketplace. “It’s the Wild West out here, and companies are doing what they can to survive,” says Ronnell Nolan, CEO of Health Agents for America, which represents independent insurance brokers. “They’re not paying commissions on platinum plans, and they are not paying them for special enrollment plans which cover some of the sickest patients.” An exodus of brokers from the federal marketplace could undermine enrollment efforts since brokers historically sign up at least 50% of exchange enrollees.
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Another insurer sued the U.S. government to recoup unpaid payments under the ACA’s risk-corridor program, but it’s looking less and less likely that the feds will ever pay up.
Sanford Health Plan, the insurance arm of Sioux Falls, S.D.-based Sanford Health, sued the federal government, demanding it pay nearly $9 million in overdue risk-corridor payments for 2014 and 2015. The CMS so far has paid Sanford Health Plan just 15.1% of the amount it owes, according to the complaint filed last week in the U.S. Court of Federal Claims.
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Healthcare advocacy groups say a bill in the Missouri Senate that seeks to transform Medicaid into a block grant program would cut necessary funding for healthcare services for Missouri’s most vulnerable citizens. But Republican supporters say it would give the state more flexibility and help it control runaway spending.
The same debate is playing out on a national stage. GOP lawmakers, including President Donald Trump, have embraced Medicaid block grants as a solution to growing costs. As Medicaid reform looks more and more like a potential reality, states are beginning to question if it’s wise to forgo some federal funding in exchange for more control.
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When the 115th Congress convenes in early January, they’ll waste no time before launching an assault on key parts of President Barack Obama’s signature health care reform law. A bare-bones budget resolution acting as a vehicle to dismantle the Affordable Care Act will get a House floor vote the week of Jan. 9, according to a memo from Rep. Greg Walden (R-OR), the incoming chairman of the House Energy and Commerce Committee, CQ Roll Call reported. That means the Senate could take up and pass the budget resolution during the prior week.
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The CMS has made a handful of final changes to the Affordable Care Act’s health insurance marketplaces for 2018, just a little more than a month before Donald Trump takes over the White House and congressional Republicans move to repeal the healthcare reform law.
A final rule published late Friday cements many of the CMS’ proposals from August. Some of the most notable changes involve the ACA’s permanent risk-adjustment program, which funnels money from insurers with lower-cost enrollees to companies that have higher-cost enrollees.
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A federal judge denied the Obama administration’s request to pause a risk-corridor case brought by Portland, Ore.-based insurer Moda Health until courts rule on similar lawsuits.
Moda Health sued the government in June for $191 million in payments owed under the Affordable Care Act’s risk-corridor program for 2014 and 2015. The CMS has paid just $11.3 million so far, and recent data from the CMS further shows that Moda is set to receive only $2.9 million on top of that from the funds collected under the program for 2015.
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Sources say President-elect Donald Trump’s transition team for HHS will be led by Andrew Bremberg, who worked at the agency under President George W. Bush administration and more recently has been an adviser to Senate Majority Leader Mitch McConnell and Wisconsin Gov. Scott Walker’s fleeting presidential bid.
Bremberg was on Walker’s team when the candidate unveiled a healthcare proposal that included repealing the Affordable Care Act and splitting Medicaid into smaller programs with separate funding.
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