The companies that sold health coverage through the Affordable Care Act public exchange system in 2015 are going over a new list that shows how much cash they could possibly get from the ACA risk corridors program — if Congress provides enough cash to cover the program's bills.
Drafters of the ACA created the risk corridors program to help compensate health insurers for all of the dramatic changes in underwriting rules, benefits rules and programs created by the ACA, and to tempt insurers into the ACA public exchange system. The program was supposed to use cash from exchange plan issuers that did well in 2014, 2015 and 2016 to compensate the issuers that did poorly.
Republicans in Congress moved in early 2015 to block program managers from using any resources other than payments from thriving exchange plan issuers to make good on program obligations.
Officials at the Centers for Medicare & Medicaid Services (CMS) said repeatedly in 2014 and early 2015 that the program would be able to pay its bills, and CMS officials pointedly told state insurance regulators to take the risk corridors program payments into account when reviewing carriers' 2016 individual health premium proposals.
Then, on Oct. 1, 2016, after regulators had locked in the carriers' 2016 rates, CMS told them that the program would collect only enough cash from thriving issuers to pay about 13 percent of the 2014 ACA risk corridors program payment bills.
This September, CMS officials warned issuers that any revenue the program collects from thriving exchange plan issuers for 2015 will go toward payments to the carriers that are still owed money for 2014.
A Federal Claims Court judge ruled earlier this month that the exchange plan issuers have no contractual right to make the government pay the risk corridors program bills.
Last week, CMS posted a document showing what CMS believes to be the exchange plan issuers' ACA risk corridors program payables and receivables for 2015.
CMS organizes the list by state, and it gives only an issuer name. CMS does not say who owns the issuer.
We compiled a list of the 20 issuers owed the most 2015 ACA risk corridors program cash and found that one company in particular, Chicago-based Health Care Service Corp., may take an especially big hit if Congress continues to insist that the ACA risk corridors program rely solely on cash from thriving exchange plan issuers to pay its bills.
Health Care Service controls Blue Cross and Blue Shield plans in Illinois, Oklahoma and Texas that could be getting a total of about $1 billion in ACA risk corridors program payments for 2015 but may not actually collect any of that money. Even if the program eventually does pay all of its bills, the payment delays could cause years of cash-flow headaches for Health Care Service and other affected carriers.
The issuers see themselves as victims of the ACA risk corridors program failure and partisan gridlock in Washington.
Some critics of the Affordable Care Act argue that the issuers brought the problem on their own heads, by participating in an ACA program after Republicans in Congress had classified it as a harmful insurance company bailout program.
For a look at a complete list of the 20 issuers on track to absorb the biggest losses as a result of the program problems, read on:
10 carriers with ACA headaches
20. Land of Lincoln Mutual Health Insurance Co.
For plans in Illinois.
Based in Chicago.
A Consumer Operated and Oriented Program carrier.
Receivable: $59,546,957.17.
19. Time Insurance Co.
For plans in Florida.
A unit of New York-based Assurant Inc.
Receivable: $61,174,353.15.
18. All Savers Insurance Co.
For plans in Texas.
A unit of Minnetonka, Minnesota-based UnitedHealth Group Inc.
Receivable: $62,422,090.52.
17. Kentucky Health Cooperative
Based in Louisville, Kentucky.
A Consumer Operated and Oriented Program carrier.
Receivable: $77,311,836.24.
16. Blue Cross and Blue Shield of Alabama
Based in Birmingham, Alabama.
Receivable: $79,476,154.29.
15. Consumers' Choice Health Insurance Co.
For plans in South Carolina.
Based in Columbia, South Carolina.
A Consumer Operated and Oriented Program carrier.
Receivable: $81,078,167.44.
14. BlueCross BlueShield of Tennessee Inc.
For Tennessee plans.
Based in Chattanooga, Tennessee.
Receivable: $83,199,959.16.
13. SelectHealth
For Utah plans.
A unit of Salt Lake City-based Intermountain Healthcare.
Receivable: $85,912,175.23.
12. Moda Health Plan Inc.
For plans in Oregon.
Based in Portland, Oregon.
