New Mexico lawsuit puts ‘Obamacare’ provision on chopping block
The
It's meant to encourage innovation in health care and discourage companies from cherry-picking the healthiest customers. Individual insurance providers can be liable for, or the recipients of, millions of dollars each year.
Suspending risk adjustment payments does not mean that most policyholders will pay more for health coverage, but it may further undermine the Affordable Care Act.
"We're talking about a small sliver of the population," said
The Affordable Care Act, enacted in
Suspending the risk payments results from a February ruling in a case filed two years ago in
In February, U.S. District Judge
The president of
Risk adjustment payments are neither a new concept nor particularly controversial. They are one of three programs in the act, and the only permanent one, intended to distribute the burden of covering the highest-risk patients among insurers.
For example, Christus Health Plan, with 2,200 New Mexicans enrolled, was scheduled to pay
Health Connections, in business since 2013, argued the formula, based on state average premiums, favored large, established insurance companies over smaller, innovative carriers. Health Connections covers about 44,000 individuals.
The company in its lawsuit didn't dispute the mandate for risk adjustment payments. It argued the formula was "arbitrary and capricious," according to its complaint in federal court.
"The flaws in [
The result, said Health Connections founder Dr.
The CO-OPs were intended to create innovative methods of reducing health care costs and spur competition.
"The main distinguishing factor written into the [Health Connections] grant was intensive medical management to better the health of the members," Hickey said. "We knew a lot of people joining us would have pent-up medical demands; most would not have had insurance or access to health care."
An expert in health care law described the government's decision to suspend risk payments as an overreaction, and not surprising in light of the Trump administration's stated goal of dismantling the Affordable Care Act.
In the wake of Browning's February ruling, the government had several options, wrote
Second, it could have sought a stay of the judge's order while it prepared an appeal. Finally, the government might have narrowly interpreted the order to apply only to New Mexico Health Connections, or any
Levitt, of
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