The number of health insurers suing the Obama administration over the Affordable Care Act’s hampered risk-corridor program continues to grow.
Blue Cross and Blue Shield of North Carolina filed a lawsuit last week, arguing it is owed $129 million in unpaid risk-corridor payments for the 2014 calendar year. The not-for-profit health plan also demanded the federal government pay legal costs and interest, according to a copy of the lawsuit.
Blue Cross and Blue Shield of North Carolina recorded more than $147 million in risk-corridor payments. However, the federal government has been allowed to pay out only 12.6% of insurers’ requests. The insurer, which has experienced high medical costs from its ACA exchange population, expects it is owed another $175 million for the 2015 benefits year as well.
Moda Health, based in Portland, Ore., filed its own risk-corridor lawsuit last week, suing for $180 million it says it is owed for 2014 and 2015. Moda has abandoned several exchanges after experiencing huge losses.
Highmark was the first major insurer to sue. According to Crain’s Business Insurance, the CMS refused Highmark’s request for full payment after the insurer tried to negotiate with the agency.
The ACA created the three-year risk-corridor program to limit how much money health insurance companies could lose or gain in the early years of the exchanges. Plans with lower-than-expected medical claims pay into the program, and plans with higher-than-expected costs receive money. However, the risk-corridors program has been caught in a political knife fight on Capitol Hill.
