Indiana Insurers Impacted By Trump Administration ACA Payments Freeze

Jul 9, 2018

Even though at least one of the companies providing Affordable Care Act insurance in Indiana temporarily saves money from a recent Trump administration move, company officials say the decision create more questions about the future of health coverage for Hoosiers.

The federal Centers for Medicare and Medicaid Services will temporarily freeze payments for the so-called “risk-adjustment” program that takes money from insurers and redistributes it to companies with more expensive patients.

CareSource, which will offer insurance in 79 of Indiana’s 92 counties in 2019, would have gone from being a net receiver of money from the pool to paying about $16 million a year to other insurers – that is, until the freeze went into effect.

One of the most popular parts of the Affordable Care Act: the fact no one can be denied coverage, regardless of pre-existing conditions. But the Trump administration is hanging its decision to withhold subsidies to insurers on court decisions from New Mexico and Massachusetts which say the way those payments are handed out is too vague.

Indiana has just three companies left which will sell ACA plans in 2019: Anthem, CareSource and Celtic.

CareSource Vice President Scott Brockman says continuing to tweak Obamacare creates additional uncertainty about the program’s future.

“If you keep monkeying around with things on the–these features and parts of the program,” Brockman says. “Again, last year you heard a lot of that. It doesn’t provide comfort, I think, to those trying to expand.”

Insurers were required to meet a June deadline to say in which Indiana counties they’ll sell insurance, as well as which kind of plans – so those are locked in, pending a state review.

According to Brockman, the temporary withholding will impact 2017 and 2018 claims, and shouldn’t affect the 2019 rates that were just filed last month.

“I can’t see the state, when they’re doing their rate reviews right now, coming back and allowing issuers to change the premiums based on what this court case came through with,” Brockman says.

But multiple insurers have issued statements in recent days saying the decision will likely force some companies to raise rates.

In the 2019 filings, the state’s largest insurance company, Anthem, will only offer catastrophic coverage in five counties next year. Celtic Insurance Company is the only firm that says it’ll cover Hoosiers in all 92 counties. Anthem declined comment on its specific circumstances.

CORRECTION: A previous version of this story said CareSource was receiving federal money from the risk pool and would have to pay $16 million. That was incorrect. Federal law requires insurers to pay into the pool, but the money is from the companies, not the federal government. Also, the $16 million payment (for the 2017 plan year) is temporarily on hold, per CMS’s order.