State health officials are expressing concerns over the latest blow to the Affordable Care Act. The ACA’s risk adjustment program has been stalled and some worry the move may raise rates.
Under the risk adjustment program, funds from insurance companies with a healthier patient pool are funneled to those whose patients are less healthy and more expensive to cover. This is meant to keep providers from only targeting healthier patients.
The Centers for Medicare and Medicaid Service announced over the weekend it would honor a New Mexico district court decision and put all of the program's payments and collections on hold, despite there being a contrary decision from a district court in Massachusetts. The freeze includes $10.4 billion in transfers from the 2017 benefit year.
Delaware Health and Social Services Secretary Dr. Kara Odom Walker says she’s concerned this will push premiums here up.
“We’re very worried about what this could mean in Delaware in particular. We’re obviously in a unique situation in our state where we have one insurer in our marketplace and have been very concerned about affordability,” said Walker.
This is latest in a series of attacks against the ACA. The Trump administration already did away with the individual mandate, cut advertisement funding and shortened the signup period for the program.
“I certainly didn’t see it coming. I’m not surprised entirely,” said Walker. “Again, we’ve seen multiple iterations of attempts to dismantle the Affordable Care Act and make it really challenging for states like ours to ensure consumers have access to affordable health coverage.”
Highmark Blue Cross Blue Shield is the sole ACA provider in Delaware—which as a state ranks 30th in overall health.
Highmark said in a statement it is “disheartened” by the decision to uphold the New Mexico court’s decision nationally, and if nothing changes “this action by the administration will most likely have an impact on rates for 2019.”
Delaware Department of Insurance Officials, however, say it is still too early to know what the effect will be on the Delaware marketplace.