Officials at the Centers for Medicare and Medicaid Services today started a new round of insurer-on-insurer wrestling, by posting preliminary Affordable Care Act risk-adjustment program figures for 2017.
The program is supposed to use cash from the health insurers that end up with healthier-than-average individual and small-group enrollees to compensate the insurers that end up with sicker-than-average enrollees. The program could shift about $3.8 billion of the $75 billion in 2017 individual major medical premium revenue that’s part of the program from one carrier to another, as well as $1.3 billion of the $52 billion in small-group revenue that’s part of the program.
Analysis of the CMS report shows that Anthem Inc., Health Care Service Corp. and other Blue Cross and Blue Shield plan operators could, in theory, get about $2.3 billion in individual major medical risk-adjustment payments for 2017.
Three other national individual market players — Centene Corp., Kaiser Permanente and Molina Healthcare Inc. — could end up having to pay $2 billion into the program.
A copy of the main report is available here.
A spreadsheet appendix that shows how much each issuer might get from the program, or might have to pay in, is available here. (CMS indicates when an issuer will have to pay into the risk-adjustment program by putting the payable figure in parentheses.)
It’s not clear how CMS will end up using the 2017 ACA risk-adjustment program report.
CMS officials said Saturday that they are freezing 2017 ACA risk-adjustment program payments.
Officials blamed the freeze on a ruling by a federal court in New Mexico. The court is moving toward blocking CMS use of the rules CMS used to run the program from 2014 through 2018. CMS officials said they are trying to get the New Mexico court to let them get the risk-adjustment program back in action.
If the courts let CMS get back to running the ACA risk-adjustment program about the same way they ran it for 2014 through 2016, insurers will soon start to fight over the preliminary figures.
Insurers will try to persuade CMS that they should get more cash from the program and pay less money into the program.
ACA Risk-Adjustment Program Basics
Since January 2014, health insurers have had to issue individual and small-group major medical coverage without considering personal health factors other than an applicant’s location.