5 new developments on ACA's risk-adjustment payments

Since the Trump administration suspended the ACA's risk-adjustment payments, there's been pushback and talk of restoring the payments meant to provide equal opportunity among insurers participating in the health law's exchanges.

Here are five developments regarding the payments: 

1. The Trump administration suspended $10.4 billion in risk-adjustment payments on July 7 after a federal court ruled the formula to determine the payments was flawed.

2. On July 13, six physician groups urged federal officials to reverse the suspension, arguing the suspension will put patients at risk of becoming uninsured.

3. Democrats in Congress have also come out against the suspension. In a letter to CMS and HHS, ranking members of various congressional committees called the suspension an effort to subvert the ACA and "yet another attempt by the Trump administration to sabotage the nation's healthcare system for partisan gain."

4. Amid the pushback, Rep. Kevin Brady, R-Texas, chairman of the House Ways and Means Committee, reportedly has sought to restore the payments and discussed the issue July 16 with HHS Secretary Alex Azar.

5. Meanwhile, Fitch Ratings said the suspension is a credit negative for insurance companies due reimbursement under the risk adjustment program, but it does not expect it to significantly affect ratings for the nation's largest insurers.

Multiple writers from Becker's contributed to this report. 


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5 must-reads on curbing insurance claim denials
RCM tip of the day: Use law firms in disputes with payers
Viewpoint: Big data, analytics can help physicians cut claim denials





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