OMB review underway to unfreeze $10B in ACA payments

The Office of Management and Budget (OMC) is reviewing a rule from CMS to unlock roughly $10 billion in payments for Affordable Care Act (ACA) insurers.

The payments, which do not include taxpayer money, are made to insurers to stabilize the ACA marketplace and prevent incentives for carriers to insure only healthy people.

CMS froze the payments on July 7, citing a court decision that found they were based on flawed equations.

The “interim rule” would take effect immediately if it is approved, but no other details are available on the OMB website other than its “Ratification and Reissuance of the Methodology for the HHS-operated Permanent Risk Adjustment Program under the Patient Protection and Affordable Care Act.” 

CMS Administrator Seema Verma defended the agency’s decision to halt the payments, stating CMS’ hands were tied by the court decision.

Insurance providers and other stakeholders spoke out against the freeze of payments, with the largest health insurance lobbying group, America’s Health Insurance Plans, noting the decision comes with “serious consequences” for consumers and brings more “uncertainty” to the marketplace.

Other critics denounced the action as another attempt by the Trump administration to undermine the ACA.