Blue Cross Blue Shield Association Statement on Risk Adjustment Payment Freeze

WASHINGTON – The Blue Cross Blue Shield Association issued the following statement today from President and CEO Scott Serota: 

“We are extremely disappointed that the administration has frozen payment transfers under the Affordable Care Act’s (ACA) risk adjustment program, which is designed to keep costs down for consumers while meeting the medical needs of those requiring significant care. Risk adjustment is a Congressionally-mandated program that supports both the individual and small group health insurance markets.

“Without a quick resolution to this matter, this action will significantly increase 2019 premiums for millions of individuals and small business owners and could result in far fewer health plan choices. It will undermine Americans’ access to affordable coverage, particularly for those who need medical care the most.

“CMS should use all legal avenues available to make the payments on schedule and should do so to protect consumers.

“Risk adjustment is a concept that has been long supported and embraced by both Republicans and Democrats through programs like Medicare Advantage. The program does not cost taxpayers any money and has worked effectively to help balance the cost of caring for those with significant health needs by ensuring that health plans are able to enroll all consumers, regardless of their health status.

“The action taken today will create turmoil not only for those in the individual market – particularly as insurers finalize their offerings for the next open enrollment that begins in November – but also for the millions of businesses that rely on the small group market to provide affordable insurance options for their employees.

“Risk adjustment is a mandatory program under federal law. CMS should take immediate action to reinstate these payment transfers to ensure the market works as intended under the law and that coverage for millions of Americans is not disrupted.”

The Blue Cross Blue Shield Association is an association of 35 independent, locally operated Blue Cross and/or Blue Shield companies.