Administration moves to address insurer complaint on ObamaCare

The Obama administration on Thursday took a step toward addressing one of the complaints from insurers about ObamaCare. 


Insurers have long pushed for a range of policy changes to address factors that they say are making the mix of ObamaCare enrollees sicker and costlier than expected, contributing to financial losses. 

One such step that the insurers have called for is cracking down on healthcare providers that are improperly steering patients into private ObamaCare marketplace plans, rather than Medicare and Medicaid. The providers can prefer the higher payments that they receive from private insurers. 

The Centers for Medicare and Medicaid Services (CMS) on Thursday announced that it is seeking public comment on actions it can take to crack down on this steering of patients by providers. 

The announcement comes three days after Aetna announced it is pulling back from the ObamaCare marketplaces, citing financial losses, setting off a new wave of discussion about fixes that are needed around the health law. 

“Today’s steps are a part of the Administration’s ongoing work to strengthen and expand the Health Insurance Marketplace,” the CMS said in a statement. 

The agency also pointed to actions it has previously taken to tighten up the rules for enrolling through extra sign-up periods. Insurers complain that sick people are gaming those periods to wait until they are sick to sign up, driving up costs. 

Despite the CMS’s actions, insurers are pushing for more changes to stabilize the ObamaCare market, such as putting in place stricter eligibility verification for the extra sign-up periods and reforming the formula used for a program called risk adjustment that makes payments to insurers who enroll sicker patients. 

Insurers also want changes from Congress, for example giving them more leeway to charge older people higher rates than younger people. Action from Congress is much less likely, though.