Author Archives: Reeve Conover

Risk Adjustment Suspension reversed by Trump

July 27-  In a reversal, the Trump Administration will resume risk adjusted payments to Health Insurers.  A few weeks ago we reported that the Administration was suspending payments to carriers under the risk adjustment payment program under the Affordable Care Act in the Individual and Small Group Markets. They now said they will restart the program that pays billions to insurers to stabilize health insurance markets.



3 recent articles covering the Trump administration’s decision to suspend Risk Adjustment payments to insurers which were intended to help insurers cover costs for sicker patients.  This will cause insurers to rethink and possibly refile their filed rates for Individual and Small Group plans for 2019.  Insurers were due to receive upwards of $10 billion dollars to offset high claimants in these markets.  This will certainly cause some turmoil and cause for debate and discussion.  In New York, Oxford has benefitted greatly from these payments, last year taking in around $250 million in payments from other carriers in New York state.  Risk adjustment payments are what also took down CareConnect, having to in essence pay over $100 million dollars to Oxford.  The risk adjustment payment programs are certainly a flawed methodology created by the previous administration, what the solution is.. no one is really certain of that, but this will certainly have some reaction to it and cause carriers to reconsider their intended filings for 2019.

We will keep you posted of new developments.

Massachusetts raises minimum wage and enacts family leave

Massachusetts now joins California, New York and Washington, D.C. as the only states to have both a $15 minimum wage and mandatory paid family and medical leave.  It also eliminates some mandatory overtime rules, and gradually phases in over 5 years.  If you are a Massachusetts-based employer or have employees there, this is a must read.  Click here.

Why health care sharing memberships continue to grow

Great article in Fox Business about how these plans work and why they are popular.  on the plus side, they are a lot less expensive.  on the negative side- they are not insurance and there is no guarantee of payment.  For the full article, click here.

EMBLEM Health expands NY NJ CT Network

EmblemHealth’s Tristate Network for Small Groups: Available to Quote Now
EmblemHealth has expanded our Prime network for small groups (1-100 employees) to include both the QualCare network in New Jersey and ConnectiCare’s network in Connecticut. The expanded Prime network will be effective for these groups July 1, 2018.

Empire Blue Cross terminates South Nassau Community Hospital

From Empire Blue Cross: “We are actively negotiating a renewal deal but we have reached a point where we are proceeding with the activities to terminate our contract effective 5/1/18.  The 60 day cooling off period ends 7/1/18 , on 5/15/18 notification letters were mailed to our members. As always we are continuing our dialogue with the facility in the hopes of reaching a mutually acceptable agreement.”

Therefore as of 7/1, at the end of the cooling off period, if no deal has been reached, South Nassau will be out of the network.


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Reeve Conover is a Registered Representative. Securities offered through Cambridge Investment Research, Inc., a Broker/dealer member FINRA/SPIC. Cambridge and Conover Consulting are not affiliated. Licensed in SC, NC, NY, CT, NJ, and CA. - SIPC - Brokercheck