Blues plans crushed by risk adjustment freeze as Kaiser skirts nearly $1B

Kaiser Permanente
Kaiser Permanente stands to save $928 million if the risk adjustment freeze holds. (Ted Eytan/CC BY-SA 2.0)

Some of Blue Cross Blue Shield’s biggest affiliated insurers would be the hardest hit by the Trump administration’s decision to freeze more than $10 billion in risk adjustment payments.

Should those payments remain frozen, three insurers—Blue Shield of California, Health Care Services Corporation and Blue Cross Blue Shield of Florida—would miss out on more than $2 billion due this fall, according to data released (PDF) by the Centers for Medicare & Medicaid Services.

RELATED: CMS suspends $10.4B in risk adjustment payments to insurers


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Blue Shield of California is owed the most at $696 million, followed by BCBS of Florida at $686 million and HCSC, a Blues-affiliated insurer, at $640 million.

The data, which outlines risk adjustment transfers for the 2017 year, comes days after the agency announced it would freeze payments, citing a New Mexico court decision earlier this year that ruled CMS must rework its risk adjustment formula. Under the Affordable Care Act, risk adjustment was meant to prevent insurers from turning away the sickest patients.

However, several other insurers would benefit handsomely from the decision. Kaiser Permanente, which operates plans in eight states and the District of Columbia, stands to save $928 million if CMS elects not to make the payments. Molina owes $852 million and Centene, including its recent acquisition of Fidelis, owes $689 million.

Critics see the delay as another effort by the Trump administration to sabotage the individual market, and the move is expected to drive up premiums and force insurers off the marketplace. But policy experts believe CMS will ultimately make the payments this fall.