Court Rejects Insurers Claims That They’re Owed Billions Under Health Law’s Risk Corridors Provision
The panel said the government doesn't have to pay insurers the money because Congress had taken action — after the health law's passage — requiring the program to be budget neutral year after year. The program in contention was aimed at enticing insurers into the market with promises of covering their financial risks.
The Wall Street Journal:
Federal Government Doesn’t Have To Pay Billions To Health Insurers, Court Rules
The federal government doesn’t have to pay insurers billions of dollars under an Affordable Care Act program aimed at enticing them into the markets by helping cover their financial risks, a divided federal appeals court ruled Thursday. In a case brought by Moda Health Plan Inc., the ruling is a blow to insurers hoping to recoup money they say they were owed under the 2010 health law. (Armour and Kendall, 6/14)
Politico:
Court: Federal Government Doesn’t Owe Insurers Obamacare Payments
A divided three-judge panel rejected claims from two Obamacare insurers that the federal government was required to make good on payments from a program meant to protect insurers who attracted customers who were sicker and more expensive than anticipated. The two insurers were seeking hundreds of millions of dollars in payments from Obamacare’s risk corridor program, and at least three dozen other insurers have filed similar lawsuits. In all, insurers say they’re owed more than $12 billion from the risk corridor program, a shortfall they have partially blamed for skyrocketing premiums and dwindling competition in the Affordable Care Act marketplaces. (Demko, 6/14)
The Hill:
Court Rules Insurers Not Entitled To ObamaCare Payments
“Congress clearly indicated its intent here,” the court ruled. “It asked GAO [the Government Accountability Office] what funding would be available to make risk corridors payments, and it cut off the sole source of funding identified beyond payments in. It did so in each of the three years of the program’s existence.” The insurers are likely to appeal and seek a review by the full court, rather than just a panel. If that doesn’t succeed, the next step would be an appeal to the Supreme Court. (Weixel, 6/14)
In other health law news —
The Washington Post:
Broad Health-Care Coalition Opposes Administration Stance In Anti-ACA Lawsuit
A broad swath of health-care constituencies weighed in on Thursday to oppose a lawsuit challenging the Affordable Care Act, forming an uncommonly united front against a decision by the Trump administration not to defend significant parts of the law. Hospitals, doctors, medical schools, patient-advocacy groups, the health insurance industry and others filed briefs in a federal court in Texas, disputing the argument of 20 Republican-led states and the Justice Department that all or part of the 2010 law is unconstitutional. In all, 11 friend-of-the-court briefs were filed. From various vantage points, each argues that a ruling in favor of this latest challenge to the ACA’s constitutionality would “have a devastating impact on doctors, patients, and the American health care system as a whole,” as a brief from the American Academy of Child and Adolescent Psychiatry puts it. (Goldstein, 6/14)