In announcing a more than 70 percent funding cut from a year ago, the Centers for Medicare and Medicaid Services said in a notice that the marketplace navigator groups should be able to "stretch their funding further" with less demand for in-person assistance because the marketplace is more familiar to most Americans. In January a federal court in MA ruled the formula wasn't arbitrary and capricious.
CMS estimates that ACA navigators that received over $36 million enrolled less than one percent of the consumers that bought a health plan through an FFE.
That's because the federal government won't distribute $10.4 billion it was expected to give insurers this fall under the Affordable Care Act's risk adjustment program. It discourages companies from trying to save money by cherry-picking the healthiest people and kicking others to the curb.
Under the bill, the tax penalty for people who fail to obtain insurance-the so-called individual mandate-was repealed, effective January 1, 2019. It's reasonable for the government to slash the program. It's bad news, as well, for all Americans who believe that nobody should be priced out of basic health care just to save the rest of us a buck.
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. In other words, the Trump Administration position in court is in favor of making the payments. "And the reason that the penetration of value-based programs-even those that have upside-only risk-[has lagged] is that reluctance and the sense that they don't have deep capital reserves, aren't prepared and equipped to handle a significant financial shock like some sort of clawback because they missed their targets", Abrams says.
The president last fall also issued an executive order to try to make it easier for individuals and small businesses to buy health plans that cost less than ACA coverage because they cover fewer medical services and bypass the law's rules meant to protect people from old insurance practices in which companies had charged higher prices to women, older people, and those with preexisting medical conditions. The administration is also pushing to broaden the definition of short-term insurance, which is also exempted from the ACA's rules. This is another act of sabotage by the administration.
The plan would replace federal payments to insurance companies with block grants to states, allowing states to "innovate" by providing low-cost, low-benefit plans. These options, not widely available, can typically charge more for pre-existing conditions and charge a hefty premium to older customers.
The administration's latest effort to undermine the Affordable Care Act comes at a particularly sensitive time for insurers. The funding will be delivered to eligible organizations that can help individuals enroll in ACA health plans.
There has been no demonstrable outrage from leading Democrats on Trump's intensifying campaign to transform Medicaid into a cut-rate voucher program or other aspects of the administration's crusade against the poor and dismantling of what remains of the social safety net.