The Trump administration has announced it is suspending so‐called “risk adjustment” payments to insurers who participate in ObamaCare’s Exchanges, and cutting spending on so‐called “navigators,” who help (few) people enroll in ObamaCare plans.
The Washington Post’s Catherine Rampell and other ObamaCare supporters are calling these steps sabotage. In fact, what these steps will do is make the costs of ObamaCare’s supposedly popular preexisting‐conditions provisions more transparent.
Risk‐Adjustment (Bailout) Payments to Insurers
ObamaCare’s so‐called “risk adjustment” program exists to funnel money to insurers who enroll lots of sick people who cost more in claims than they pay in premiums. Without it, insurers probably wouldn’t participate in ObamaCare. We may therefore confidently describe the risk‐adjustment program as a bailout designed to rescue insurers from the costs of ObamaCare’s preexisting‐conditions provisions.
The risk‐adjustment program does a better job of protecting insurance companies than sick patients. Those preexisting‐conditions provisions literally punish insurers for offering coverage that the sick find attractive. They therefore create powerful financial incentives for insurers to make their offerings unattractive to the sick.
The risk‐adjustment program is supposed to counteract those incentives. Anecdotal evidence and empirical research both show it’s not working. The risk‐adjustment program is failing to counteract the perverse incentives that ObamaCare itself creates. ObamaCare coverage is therefore getting worse for many sick patients. Don’t worry, the insurance companies come out okay. Insurers can mitigate whatever losses the bailouts don’t cover with even more restrictive benefit designs to keep the sick away. Sick patients fare less well.
Reducing or eliminating spending on the risk‐adjustment program would reveal more of the harms of the preexisting‐conditions provisions. More of the cost would fall on insurers, who would respond by offering even more restrictive coverage, or exiting the market. More such transparency might finally push Congress to repeal those provisions and put health care for the sick on a more stable footing.
In February, a federal district court in New Mexico ordered the Centers for Medicare & Medicaid Services to cease using its methodology for making risk‐adjustment payments until the agency adequately explains that methodology. On July 7, the agency announced it will not make any risk‐adjustment payments until the issue is resolved.
The insurers will eventually get their bailouts. But the delay will cost them money and add uncertainty to the process. Those effects in turn may lead insurers to take even greater steps to protect themselves from the costs of the preexisting‐conditions provisions—thereby making those costs more transparent.
Cutting Navigator Spending
ObamaCare authorizes CMS to make grants to “navigators”—i.e., groups who are supposed to help people enroll in ObamaCare plans. They are a waste of taxpayer money, and likewise hide the costs of ObamaCare’s preexisting‐conditions provisions.
According to CMS, navigators received $63 million for plan year 2017 and $36 million for plan year 2018. In both years, they signed up less than 1 percent of ObamaCare enrollees. “During grant year 2016–2017,” CMS reports, “seventeen of those Navigators enrolled fewer than 100 people at an average cost of $5,000 per enrollee.” That’s more than the cost of the health insurance, in many cases. The Wall Street Journal reports, “One grantee took in $200,000 to enroll a grand total of one person. The top 10 most expensive navigators collected $2.77 million to sign up 314 people.” The Las Vegas Review‐Journal editorializes, accurately, “the navigator scheme is a make‐work government jobs program rife with corruption and highly susceptible to scam artists. It’s a slush fund for progressive constituent groups.”
The navigator program also hides the cost of ObamaCare’s preexisting‐conditions provisions. Since the sick will reliably enroll in ObamaCare even without navigators, those whom navigators end up enrolling are going to be disproportionately healthy. Thus navigators are also helping to hide the costs of those provisions by spreading the costs across more (healthy) people. Cutting spending on navigators will likewise reveal more of the costs of those provisions.
The Trump administration announced it is cutting spending on navigators to $10 million for plan year 2019. It should eliminate the program entirely. The less the federal government spends on navigators, the more transparent ObamaCare’s costs will be.
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When ObamaCare supporters complain about such steps, they are describing transparency as sabotage. Think about what that means.
