Older story but SO relevant for today!
This is about a raid conducted in the murky twilight of the Federal Register. It’s a scheme in which the Obama administration collected less in taxes from health insurers (mostly off the Exchanges) than they were required to do under the Affordable Care Act, created a plan to pay insurers selling policies on the Exchange considerably more than originally projected, and stiffed the United States Treasury on the money it was supposed to receive from the taxes. It’s a different bailout than the Risk Corridors program. That, at least, was originally authorized by statute. This is about a diversion that took place in spite of a statute that explicitly prohibited it. And the consequence of the diversion of funds was to enrich insurers and, probably, to keep more insurers selling policies on the Exchanges than would otherwise be the case.
The scheme involves section 1341 of the Affordable Care Act, so-called Transitional Reinsurance. If you actually read the statute and know some history, the concept behind it is fairly clear. Prior to the ACA, most states were operating subsidized high risk pools for their sickest citizens. They did so because insurers were generally permitted to engage in medical underwriting and refused to cover such persons except possibly at very high prices. Often, eligibility for participation in the subsidized state high risk pools was conditioned on having one or more of a list of diseases that were expensive to treat.
The ACA envisioned a two step transition to deal with these high risk individuals. From 2011 through 2013, the federal government itself operated a high risk pool called the Pre-existing Condition Insurance Plan that would basically soak up many who had been with state high risk pools or others who had pre-existing conditions that made them difficult to insure. The PCIP was somewhat of a fiasco, but that’s a story for a different day.
From 2014 forward, the federal government would no longer directly insure individuals with expensive pre-existing conditions. Instead, it placed the burden on private insurers who chose to sell policies on the Exchanges or certain policies off the Exchanges. These insurers would no longer be able to medically underwrite and to exclude or charge more to people with these pre-existing conditions. The idea of Section 1341 was to make this generally bankrupting practice more enticing. It called for provision of “free” reinsurance to Exchange (and some other individual) insurers based on claims incurred by insureds with any of 50 to 100 high risk conditions that the regulatory processes had identified. This “transitional reinsurance” would be operated by the states and would run from 2014 to 2016. It was essentially a gift card to the insurance industry, almost as good as cash, since specific stop loss insurance of the sort provided was something many insurers might well get anyway.
There was another related problem to take care of to which reinsurance had been the answer. Under section 1102 of the ACA, the federal government was going to put up $5 billion in 2010 to 2013 to reduce the burden on employers — mostly state government employees — and labor unions that had agreed to provide group health insurance to persons who had retired but who were not yet 65 and eligible for Medicare. Many sponsors of these plans, particularly the private corporation providers, were dropping them, but this response to rising healthcare costs endangered the ACA. Those newly uninsured people — the high risk group over age 55 — would migrate to the Exchanges on the ACA, where their high expenses would drive up premiums and increase the subsidies paid by the federal government.
Read the rest at: Obama raided the fed