Risk Adjustment Freeze

2018 MIDTERM ELECTION

Time: D H M S

In my Tennessee 2019 rate filing analysis last month, I noted the good, the bad and the ugly:

  • The good news was that average unsubsidized 2019 ACA individual market premiums were expected to drop by about 5.7% after years of double-digit rate hikes.
  • The bad news was that due specifically to various types of deliberate sabotage by the Trump Administration and Congressional Republicans (primarily repeal of the individual mandate and expansion of #ShortAssPlans), that 5.7% drop was still a good 12 points or so higher than it otherwise would have been.
  • The ugly news was that due specifically to the Trump Administration's utterly unnecessary decision to freeze Risk Adjustment fund transfers in response to a lawsuit out of New Mexico, 2019 premiums would be hundreds of dollars higher still than they should have been for Blue Cross Blue Shield of Tennessee's 113,000 enrollees:

 

Less than three weeks ago, the Centers for Medicare & Medicaid (CMS) dropped a Friday night bombshell: In response to a judicial ruling in a federal lawsuit brought by a small New Mexico insurance carrier, CMS had decided to temporarily "freeze" the transfer of roughly $10.4 billion in Risk Adjustment funds either owed to or owed by several hundred carriers nationwide.

The whole story about how the Risk Adjustment (RA) program, what the lawsuit is about and why the funds were frozen gets pretty wonky, but the bottom line is...

A few days ago I noted that Blue Cross Blue Shield of Tennessee, which holds over 50% of TN's ACA-compliant individual market, specifically noted in their individual market rate filings that while they're lowering rates by 10.9% on average in 2019, they had been planning on lowering rates considerably more prior to the bombshell announcement that CMS has decided to "freeze" Risk Adjustment fund transfers for an unknown period of time. Specifically:

“Our rate reduction would have been larger, but we had to account for added uncertainty in our rates due to indefinite suspension (the U.S. Centers for Medicare and Medicaid Services) placed on risk adjustment transfers between insurers,” said , said Mary Danielson, a BCBST spokeswoman. “Again, we were planning a larger reduction – around 18 percent – but needed to factor in the prospect of greater costs for 2019.”

Holy guacamole. I've noted repeatedly that unlike last fall, when average rate increases of 20-30% or more were commonplace for ACA individual market policies (due mainly to Trump cutting off CSR reimbursement payments), the preliminary rate requests for 2019 are actually averageing quite a bit lower than originally expected; of the 20 or so states I've crunched the numbers for so far, the weighted average for unsubsidized premium hikes is hovering around the 10% mark.

At first glance, it may sound like Democrats have been overplaying their hand when it comes to the "individual mandate repeal/short-term plan expansion is causing massive hikes!" attack. However, the rate increases from deliberate sabotage are happening...they're just being partly cancelled out by other factors, including:

Over the weekend, CMS dropped a big bombshell on everyone: In response to a federal judge siding with a small insurance carrier in New Mexico in a lawsuit over the formula for the ACA's Risk Adjustment (RA) formula, the Trump Administration has decided not to transfer any RA funds for the 2017 calendar year to anyone until...well, I'm not sure exactly, but for the foreseeable future.

Pretty much expert on how the RA program (and the law) has indicated that this is completely unnecessary; there's several responses at CMS's disposal which wouldn't require throwing the entire industry into a panic (yet again). Regardless, this is where we're at.