In the first three years of the PPACA, a Risk Corridor Program was established to help insurers get past the initial loss phases. This is typical of startups and was used with Republican President George Bush’s Part D Drug insurance program. The PPACA had built-in protections for insurers who enrolled many abnormally sick people, provided backup payments for very high-cost cases, and protected against big losses and gains during the first three years. Due to eliminating all “pre-existing conditions” with the implementation of the PPACA, this was the protection for companies and the incentive to take on the people with health issues. Not only did it help Insurers cover their losses; but, it was an incentive for insurers not to increase premiums. Much of the funding for the program comes from the Federal Government and profitable Insurance companies paying into the Risk Corridor fund which unprofitable companies use to recoup losses. However in the first three years losses exceeded funding from profitable companies due to a Republican Congress passing laws forcing the Risk Corridor Program to be budget neutral leaving 12.6% of the necessary funds available to make insurance companies whole. As many probably know, the shortfall of funding already forced many CO-OPs to go bankrupt and resulted in Healthcare Insurance companies pulling out of the Exchanges.
Those Healthcare Companies still a part of the PPACA have gone to Federal Court to sue the administration for sustained losses. Moda Health sued the administration for $191 million due to losses in implementing the PPACA supposedly covered by the Risk Corridor Program. Moda has dropped its program in Alaska as a result of its losses and has only received ~$14 million. The Risk Corridor Program ended in 2016 and companies now face the issue of never recouping losses beyond just this.
Interesting how the Republicans have been the proverbial slugs in the process and took advantage of the crisis they created by forcing the PPACA to be budget neutral when the Part D Drug Program had no restrictions. They limited how the PPACA can fund the same Risk Corridor Program used for George Bush’s Part D Program. In September of this year, “ five Republican Senators sent HHS Secretary Burwell a letter demanding how HHS is handling a much-maligned insurance provision within the Affordable Care Act. Earlier this month, the CMS had sent a memo to health insurance companies that said the agency would not be making risk-corridor payments for 2015 because any collections would be used to cover the $2.5 billion shortfall from 2014.”
Under the PPACA Budget Neutral Act passed by the Republicans, the administration (DOJ) must now defend the law claiming they were not guaranteed the massive payouts in the first place. In November Republicans introduced the “HHS Slush Fund Elimination Act,” which restricts the Administration from using any Federal funds for the Risk Corridor Program to settle with the healthcare companies owed money.
“We are going to repeal and replace Obamacare but, in the meantime, the last thing Americans need is for the Obama Administration to sneak in one last bailout on its way out the door,” Sen. Ben Sasse (R-Neb.)”
You can see;
– Why United Healthcare pulled out of the PPACA Exchange early as it did when a Republican controlled Congress reneged on the funding for the Risk Corridor Program to cover losses in the startup of the PPACA.
– Why Healthcare Insurance companies losing money would resort to increased premiums to compensate for the lack of Risk Corridor Program funds to cover the startup and losses.
– Why the Part D Drug companies have become successful and competitive amongst each other due to their successful startup with the availability of Risk Corridor Program funds.
All of this was an effort to deny the PPACA an opportunity to be successful by a Republican Congress who would deny its constituents healthcare just to get even with a President they did not like and deny him a legacy. Risk Corridors and associated programs still exist and will continue to exist for Medicare Part D; but then, this was pre-Obama and occurred under Republican President George Bush. No one called it a bailout then.
Furthermore, do you think any healthcare insurance company would ever want to be a part of a Government Healthcare plan for the public as implemented by Republicans after they have been repeatedly screwed by Congressional Republicans?