A Court Case in New Mexico has Stopped Federal Obamacare Payments Covering Sicker Patients

A Court Case in New Mexico has Stopped Federal Obamacare Payments Covering Sicker Patients


When we think of Obamacare, we usually think about how policy in Washington D.C. may change it. This time, it is a federal court in New Mexico that has had an impact on how the program operates, and they have done the greatest damage to patients who need coverage the most.

The trial court’s ruling prevents the Centers for Medicare and Medicaid Services (CMS) from making collections or payments under the risk adjustment program. There are some disputed problems with how some calculations within the program have been working. The CMS has stated that their hands are tied until the litigation is resolved. They say that there are now billions of dollars of risk adjustment payments on hold that they are unable to distribute because of the ruling.

The risk adjustment program takes money from lower-risk health care insurance payers and distributes it to help pay for the care and coverage of sicker patients. This shares the cost of providing coverage for the people who need it more.

The methodology of risk adjustment has been supported by both Republicans and Democrats. The CMS is currently asking the court to reconsider the decision.

Scott Serota, president of Blue Cross and Blue Shield, made a statement:

“This action will significantly increase 2019 premiums for millions of individuals and small business owners and could result in far fewer health plan choices. It will undermine Americans’ access to affordable coverage, particularly those who need medical care the most.”

The America’s Health Insurance Plans trade group emailed out a statement saying that the decision will have major consequences for million of consumers. It may create market uncertainty and cause premium increases which will put a heavier burden on small businesses and consumers as well as further limiting coverage options and health plan choices.


Everyone is hoping for a quick resolution. 

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Catherine Marucci
Catherine Marucci

A dedicated writer of health, technology, and internet phenomenon news.

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