6 physician groups urge CMS to reverse $10.4B cut in ACA's risk-adjustment payments

Six physician groups called on CMS to reverse its decision to suspend $10.4 billion in risk-adjustment payments from health insurers selling policies on the ACA exchanges, according to a July 11 statement.

The physician groups argued that suspending the payments will put patients at risk of losing health insurance coverage.

"The suspension of risk adjustment payments could lead to significant premium increases across the country resulting in families, especially those with chronic health conditions and pre-existing conditions, losing their healthcare coverage due to insurer departures from the market or the inability to afford coverage," the groups wrote. "This decision contradicts the Administration's pledge to provide individuals and families with more options to secure affordable healthcare coverage."

On July 7, the Trump administration suspended the "risk adjustment" program. It was established under the ACA to encourage insurers to participate in the ACA marketplace and accept all customers without charging more for patients in need of substantial medical services. In addition, it was put in place to protect insurance companies from major losses. The program collects money from insurers with fewer high-cost members and transfers those funds to insurers with more high-cost members.

The following organizations jointly issued the statement. Collectively, the groups represent 560,000-plus physicians and medical students:

American Academy of Family Physicians
American Academy of Pediatrics
American College of Obstetricians and Gynecologists
American College of Physicians
American Osteopathic Association
American Psychiatric Association

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