Why some issuers hate the ACA risk-adjustment program
Court rulings permitting, the Blues could get $2.3 billion. Kaiser, Centene and Molina could pay $2 billion.
By Allison Bell|July 16, 2018 at 10:01 AM
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Officials at the Centers for Medicare and Medicaid Services have started a new round of insurer-on-insurer wrestling, by posting preliminary Affordable Care Act risk-adjustment program figures for 2017.
The program is supposed to use cash from the health insurers that end up with healthier-than-average individual and small-group enrollees to compensate the insurers that end up with sicker-than-average enrollees. The program could shift about $3.8 billion of the $75 billion in 2017 individual major medical premium revenue that’s part of the program from one carrier to another, as well as $1.3 billion of the $52 billion in small-group revenue that’s part of the program.
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