Obama administration may use obscure fund to pay billions to ACA insurers

By Amy Goldstein
September 29 at 12:25 PM - The Washington Post

The Obama administration is maneuvering to pay billions of dollars the government owes to health insurers under the Affordable Care Act, potentially resorting to an obscure Treasury Department fund intended to cover federal legal claims.

Justice Department officials have told several health plans suing the government over the unpaid money that they are eager to negotiate a broad settlement, which would allow the administration to compensate about 170 other insurers selling coverage in ACA marketplaces, according to insurance executives and lawyers familiar with the talks.

The efforts in recent weeks reflect the partisan thorns that still surround the sprawling law six years after its passage. The payouts probably would be made from the Judgment Fund, a 1950s creation that is allowed as much money as it needs to satisfy valid claims against the government. Such a move would bypass congressional Republicans, who have criticized certain ACA provisions as industry “bailouts” and blocked the Health and Human Services Department from paying health plans what they are owed.

In the waning months of the Obama White House, administration officials are continuing their upbeat portrayal of all aspects of the health-care law, one of President Obama’s main domestic achievements. Behind the scenes, they think that settling these claims — $2.5 billion for 2014 and an as-yet-undisclosed sum for 2015 — is crucial to the exchanges’ well-being at a time when the high cost of covering ACA customers has driven some small insurers out of business and prompted several large ones to defect from marketplaces for the coming year.

“It’s a legacy item for the White House,” said Dan Mendelson, president of the health consulting firm Avalere and an adviser on the payout effort. “It’s more than just a lawsuit. It’s really about the future . . . and stability of these markets.”

Even with a settlement still uncertain, GOP lawmakers are beginning to cry foul. “It’s an end run on the clear . . . intent of Congress,” said Rep. H. Morgan Griffith (Va.).

The money in question involves one of three strategies to help coax insurers into the ACA marketplaces by promising to cushion them from unexpectedly high expenses for their new customers. This particular strategy, known as “risk corridors,” was for the marketplaces’ early years, when it was unclear how many people would sign up and how much medical care they would use.

The risk corridors started in 2014 and run through this December. The idea, patterned after a similar arrangement for health plans that sell Medicare drug benefits, is to balance out insurers’ costs by requiring those with unexpectedly low expenses to pay into a fund that would be used to compensate companies with unexpectedly high expenses. The program originally was not supposed to pay for itself, but two years ago the Republican-led Congress restricted HHS from using any of its other money for that purpose.

The crunch first became apparent last fall, when federal health officials announced that they could make less than $400 million in 2014 risk corridor payments — just 12.6 percent of $2.9 billion overall. About 175 insurers are owed money, according to an HHS list.

Health officials have not said how many insurers need to be paid for 2015, how much they are due or how much money is available. But in a five-paragraph memo this month, HHS’s Centers for Medicare and Medicaid Services (CMS) said that any available money will be put toward what the government still owes for the previous year.

The risk corridor payments are “an obligation of the federal government,” Andy Slavitt, CMS’s acting administrator, told a recent House hearing.

The shortfall has contributed to the collapse of more than half of the 23 nonprofit, consumer-oriented health plans created under the ACA. Four of those co-ops are among the seven insurers suing the government, the most recent this week.

CMS spokesman Aaron Albright referred questions to the Justice Department. Justice spokeswoman Nicole Navas declined to confirm the settlement talks because the litigation is pending.

One health plan executive, whose attorney has spoken with Justice officials, said the department is trying to reach an agreement with suing insurers in the next two weeks on what percentage of the remaining $2.5 billion would be paid out for 2014, as well as for a 2015 amount. At that point, the same offer would be made to every other insurer owed money. A judge would need to approve the arrangement, according to the executive, who spoke about the pending litigation on the condition of anonymity.

Treasury’s Judgment Fund would most likely be the source of the money, the executive and others involved said. The fund’s website shows that it has been used for a few hundred claims against HHS in the past decade. Taken together, they amounted to about $18 million — a fraction of what the insurers are owed.

News of the settlements talk Thursday morning prompted an immediate online debate, with some people condemning the potential use of Treasury’s fund for the payments and others wondering whether those should be guaranteed through the risk corridors’ third year as well.

Stephen Swedlow, a lawyer for Health Republic Insurance in Oregon, a co-op that was forced to close early this year, said he is preparing a settlement proposal to send to Justice. Said Health Republic chief executive Dawn Bonder: “I don’t think DOJ is making a secret that they would like [the lawsuits] to go away.”