The program is seen as a crucial protection that helped entice insurers into the fledgling marketplaces even though they had little knowledge about who would purchase their plans and how much their medical care would cost. Health plans that attract a disproportionately unhealthy population will receive payments from HHS to mitigate their losses, while plans that enroll less-expensive customers will be required to make payments to the federal agency.
The risk corridors program runs through 2016. The Obama administration has indicated the program will be budget neutral. HHS has not made any payments to insurers so far, but it plans to do so in the fiscal year that starts Oct. 1.
In response to the GAO inquiry, HHS indicated that the agency already has the authority to fund the program under existing appropriations. “The CMS PM appropriation permits HHS to collect, retain, obligate, and expend the user fees in a manner consistent with section 1342 (of the ACA),” wrote William Schultz, the agency's general counsel.
Republicans decried that stance as another example of the Obama administration's abuse of executive power. “Chalk up another executive fiat for this imperial presidency,” said Rep. Fred Upton (R-Mich.), chairman of the Energy and Commerce Committee, in a statement at the time.
But Loren Adler, research director for the Committee for a Responsible Federal Budget, points out that a similar risk-protection program in the Medicare prescription drug program does not receive an explicit annual appropriation, yet has not been challenged. He thinks that makes it highly unlikely that HHS will be deterred from making the payments to insurers under the risk corridors program.
“This is a pretty big deal to insurers,” Adler said. “I can't imagine that it will let a CRS or GAO opinion stop them from doing that.”
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