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Speaker 1: Bloomberg b in a. Maryanne Pezanowski, speaking of medicine and healthcare,

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Speaker 1: does a lot of work in exceptionally narrow close articles

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Speaker 1: on what's really going on with healthcare. She is here

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Speaker 1: to give us an update on the huge controversy that

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Speaker 1: is the Affordable Character Where does the Act stand now, Marianne?

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Speaker 1: Is this an act now embedded in our day to

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Speaker 1: day law and life? Oh? I think it is. UM.

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Speaker 1: I think providers are having to meet new payment models

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Speaker 1: because of it. I think insurers are having to pay

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Speaker 1: out claims that they hadn't in the past. They have

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Speaker 1: now under the a c A. They required to issue

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Speaker 1: policies to people that they weren't required to do so before.

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Speaker 1: And the Republicans have tried and failed several times to

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Speaker 1: repeal it. So I think we're it's here to say,

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Speaker 1: lost in the efforts to repeal is the truth that

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Speaker 1: every major program launched by the government is the same thing,

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Speaker 1: and probably private sector. It needs to be tweaked, and

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Speaker 1: there are efforts underway to do that. You're writing about

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Speaker 1: one that is UM looking at the ACTS Risk Adjustment Program,

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Speaker 1: and I want you to first tell me what that is,

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Speaker 1: and then you can explain why Evergreen Health co Op

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Speaker 1: needs changes. Okay, Well, UM Congress recognized that when they

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Speaker 1: they were banning UM insurers from refusing to enroll people

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Speaker 1: who have who are in what are called high risk categories.

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Speaker 1: That is, people who will need a lot of medical care,

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Speaker 1: maybe they have chronic conditions, that sort of thing. UM

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Speaker 1: diabetes is a frequent example given UM that they had

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Speaker 1: to help out the insurers somehow, that we didn't want

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Speaker 1: people losing money, so that there's adjustment program. What they

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Speaker 1: did is insurers to enroll a lot of people are

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Speaker 1: in that high risk category would receive payments from insurers

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Speaker 1: who enrolled people who were in lower risk categories. It

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Speaker 1: was an effort to balance it out so that no

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Speaker 1: insurer would be looking to enroll only the what would

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Speaker 1: happen the the young invincibles? They were called our staff basically,

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Speaker 1: then there are our staff. Where where do we stand now?

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Speaker 1: And the idea that we're seeing litigation threat suits because

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Speaker 1: insurance companies can't make money at this where within all

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Speaker 1: your fabulous reporting on this, is that true they can't

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Speaker 1: make money? I don't think that's true. I think what's

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Speaker 1: what the problem is is that certain insurers are saying

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Speaker 1: that they can't certain insurers the new market entrance, which

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Speaker 1: is the co ops for the most part, Evergreen, which

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Speaker 1: is the case I roamed about. The Evergreen Carvern Maryland

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Speaker 1: is making money. They're healthy, they're they're not at risk

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Speaker 1: of failing, and yet they're facing potential twenty two million

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Speaker 1: dollar payment that will be made to an insurer that

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Speaker 1: was really established in the Maryland market just because that

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Speaker 1: established ensure had longer history with its nealeans and could show,

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Speaker 1: according to the federal government criteria, that it had a

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Speaker 1: lot of rollees in those high risk categories. Evergreen, because

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Speaker 1: it didn't have a long history, couldn't make the same

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Speaker 1: showing based on the evidence that the government requires it

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Speaker 1: to put in. They the Canarian and to bring up

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Speaker 1: a phrase Tom loves Canary in the coal mine. Here

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Speaker 1: they first ones to bring this up. And we're going

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Speaker 1: to see a flood of lawsuits on this. That's what

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Speaker 1: the CEO of Evergreen told me the other day. He

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Speaker 1: said that, first off, what's interesting about the risk quarter

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Speaker 1: program excuse me, there is an adjustment program. Is it

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Speaker 1: applies to all insurers, not just these co ops, not

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Speaker 1: just two insurers. That sell plans on the marketplaces or exchanges. Um.

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Speaker 1: It's also a permanent program, and this is one that's

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Speaker 1: supposed to go on until somebody repeals it. Um. So,

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Speaker 1: the CEO of Evergreen told me he's already had other

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Speaker 1: insurance companies contact him and asked for copies with their complaint,

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Speaker 1: with an eye towards you know, follow on litigation later on.

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Speaker 1: Thanks so much, Marian Pazianowski greatly appreciate it. With Bloomberg

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Speaker 1: being a on the Affordable uh Care Act,