After facing losses on the Affordable Care Act exchanges, many payers sued the federal government, arguing the ACA's risk-corridor program was flawed, according to The Wall Street Journal.
Here are five points:
1. In mid-September, CMS Acting Administrator Andy Slavitt said the agency may be discussing possible settlements with payers.
2. At a hearing, Rep. Morgan Griffith (R-Va.) asked Mr. Slavitt if any CMS member was speaking with the Department of Justice about settlements with the payer, to which Mr. Slavitt said, "I know that our general counsel speaks to Justice regularly, so I assume that they have, but I don't know any details."
3. On Sept. 22, 46 House Republicans signed a letter sent to HHS Secretary Sylvia Mathews Burwell stating they strongly oppose any proposed settlements to payers and could potentially sue the Obama administration to stop the settlements.
4. In fall 2015, HHS told payers it would only pay the 12.6 percent of the money they claimed under the risk-corridor program for 2014. HHS said in a memo on Sept. 9 that it recognized the ACA law mandates the government to pay insurers in full and it expects to use 2015 risk-corridor collections toward 2014 payments that are owed. The agency also said it would consider using other funding sources to repay insurers.
5. The Obama administration is concerned leading payers Highmark and Blue Cross Blue Shield may leave the ACA marketplace after suffering huge loses. Major payers including Aetna, UnitedHealth Group and Humana decreased their ACA presence after suffering huge losses.
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