Deep inside the massive short-term spending bill awaiting President Obama’s signature are provisions that could rattle the insurance industry.

The $1 trillion Consolidated and Further Continuing Appropriations Act of 2015 — the “Cromnibus” — contains a handful of regulatory and funding changes for portions of the Affordable Care Act, including budgetary mandates for the risk corridors program, revisions to how the medical cost ratio applies to Blue Cross insurers and cuts to the Medicare Independent Payment Advisory Board.

The provision that could have the most impact on insurers is section 227, prohibiting the Centers for Medicare & Medicaid Services from transferring funds between accounts to pay for the cost-sharing risk corridor program, where regulators collect fees from individual and small group public exchange plans with profit margins above three percent and redistribute them to plans with negative margins under three percent.

The ACA created the temporary risk corridors as part of the “3Rs” market stabilization program, but provided no additional funding for any shortfalls. Preparing to pay out 2014’s risk corridor shares next year, CMS is expecting the program to be budget neutral over its three years, but in event of a shortfall will pay claims proportionally and carry over obligations.

A shortfall could mean some temporary or lingering losses for insurers, who’ve factored risk corridor payments into premiums for 2014 and 2015, as well as their capitalization reporting to state regulators.

Over the past year, as numerous Republican lawmakers have dubbed the “3Rs” a “bailout,” America’s Health Insurance Plans, also known as AHIP, has tried to dissuade Congress from changing the program. “The risk corridor program will limit volatility in the individual and small group markets, resulting in a more stable marketplace and options for consumers that accurately reflect the cost of coverage,” the group said in statements earlier this year.

Nonetheless, Congress passed the provision in the 1,603-page bill, and President Obama is slated to sign it.

If risk corridor payments fall far short of insurer claims, premiums “may be higher for 2016, the first year in which insurers can make adjustments, and some insurers may leave the marketplaces or face capitalization issues,” noted Washington and Lee University law professor Timothy Jost, in Health Affairs,

Elsewhere in the budget bill, insurers may not have much to worry about, and those with Blue Cross licenses may actually benefit.

Section 102 of the bill redefines the medical cost ratio requirements for Blue Cross Blue Shield plans, who under the ACA have had a slightly different treatment than other plans. They were effectively barred from calculating quality improvement activities in the 85 percent proportion of medical expenses.

Now, Blue Cross and Blue Shield insurers can count quality improvement spending in their MCRs and go back retroactively to 2010 to amend four years of their accounting.

Among other healthcare provisions in the budget bill is one that lets expatriate health plans meet the ACA’s essential coverage requirements and individuals enrolled in them meet the individual mandate. As Jost noted, it’s a very complicated provision, but basically means that individuals on expat plans meeting basic guidelines can satisfy the individual mandate, while employers and insurers offering expat plans will not be subject to most of the requirements of the Affordable Care Act, including the health insurer fee.

Congress also took a “substantive swipe” at the ACA’s Independent Payment Advisory Board, as Jost put it. The bill rescinds $10 million in appropriations for the IPAB, which has still not been set up but looms over the healthcare system with what the ACA contemplates as an independent body with authority to try to improve Medicare’s financial and clinical performance.