New Mexico Health Connections, a small health insurer in the Mountain States region, is welcoming the move by the Centers for Medicare and Medicaid Services (CMS) to freeze the Affordable Care Act risk-adjustment program.
The program is supposed to use cash from health insurers that end up with relatively low-risk individual major medical and small-group enrollees to compensate insurers that end up with higher risk enrollees. CMS says it will have to freeze the program temporarily because the U.S. District Court in New Mexico has blocked its ability to use its current risk-adjustment procedures.
America’s Health Insurance Plans and the Blue Cross and Blue Shield Association have put out statements predicting that the program freeze could lead to big increases in 2019 individual and small-group premiums.
New Mexico Health Connections said Monday that a new CMS risk-adjustment program report shows that, in New Mexico, the program is doing more harm than good.
“The CMS report proves the formula the federal court in New Mexico vacated in fact does have a terrible reverse Robin Hood effect for the people of New Mexico,” New Mexico Health Connections said in a statement. “It validates the position that new and small local health plans are disproportionately disadvantaged by the current risk adjustment formula.”
The report shows that a unit of Health Care Service Corp., which is a large, Chicago-based Blue Cross and Blue Shield plan operator, and Molina Healthcare Inc., are on track to receive payments.