Thread by @ASlavitt

BREAKING: Trump aims severe blow at ACA, says payments for insuring sicker individuals (called risk adjustment) will not be paid for prior years.

This is aggressive and needless sabotage of the ACA. Impact likely chaos.

I have more details. Follow here if interested. 1/

The aim of this, reported in the Journal 👇 but not expected until next week, is to cut back about 10% of the payments insurers are owed— those for covering the sicker.

Doing this now likely aims to get insurers to abandon the ACA at just the end.

@StephArmour1 @annawmathews 2/

This has a lot of similarities to Trump and DOJ taking a court case to stop protections against pre-ex conditions.

In this case, there is a court case in New Mexico with a simple remedy for the Administration.

Details👇3/

healthaffairs.org/do/10.1377/hbl…

Even Trump’s HHS stated in the case in question that what is happening would be “disruptive for insurers, policyholders and state insurance markets.”

That apparently is exactly what those in (what I assume we will learn to be) the White House wanted. 4/

Quick explanation is that HHS assumes payments need to be made in a budget neutral fashion. 1 court ruled that has been clearly enough stated as a rationale. New Mexico believes that needs to be made clearer.

Not a reason to stop all the payments unless politically motivated. 5/

HHS could issue what is known as an “interim final rule” to clarify and resolve everything.

But instead Trump is using this as a big bullet in hopes of finally killing the ACA.

How? . . . 6/

Last year at the 11th hour, Trump ordered CSR payments stopped. He hoped this would cause insurers to exit. Instead it backfired as states helped insurers adjust their pricing. 7/

Next he introduced plans that would take all the good risks away from the market with poor benefits and signed a law driving up prices by eliminating the mandate provision.

But none of it worked other than to raise prices and make him look bad. But something else happened. 8/

All of this caused many insurers to leave many places with only one or two insurers.

No his goal in holding a large sum of money owed to them would be to create enough chaos that insurers leave and many can’t find ACA coverage. 9/

Some people’s reality is being able to affordably care for their families.

For Trump, his reality is to be able to stand at a rally and say he has killed the ACA. 10/

The Republicans did this before. Led by Marco Rubio they cut what amounted to $12 billion in Risk Corridor payments to insurers.

This put many small insurers out of business and caused others to withdraw from the market. Small nonprofit community plans need this funding.11/

At every turn, at every opportunity, Trump and the Rs in Congress will continue to aim to damage or kill the ACA.

This is one more shot at Americans’ health care. /end