Affordable Care Act

Issues

This case would have asked the Court to determine whether Section 504 of the Rehabilitation Act, which prohibits discrimination based on disability, provides a cause of action for disparate impact claims. Numerous John Does use CVS Pharmacy’s prescription plan for medication to treat HIV/AIDS, which only allows drugs to be dispensed through mail or CVS pharmacies. These John Does sued, arguing that this plan had a disparate impact on individuals living with HIV/AIDS and meaningfully impacted their health. Petitioners CVS Pharmacy et al. contend that claims under Section 504, which is incorporated in Section 1557 of the Affordable Care Act, require evidence of discriminatory intent or differential treatment. Respondents John Doe, et al., argue that Section 504 provides for disparate impact claims. Although this case will no longer be argued in front of the Court, due to an agreement for dismissal by the parties, the case could have had implications for the administration of health insurance and pharmacy benefits programs, and the risk of litigation.

Questions as Framed for the Court by the Parties

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Issues

This case concerns whether certain government task forces can issue binding recommendations without violating the Appointments Clause of the Constitution. The Health and Human Services (“HHS”) Department Preventative Services Task Force (“Task Force”), currently appointed by the HHS Secretary without the confirmation of the Senate, offers binding recommendations concerning mandatory coverage by employer insurance for certain preventative treatments under the Affordable Care Act. Braidwood Management contends that these recommendations by the Task Force are illegitimate because the members were not appointed by the President and confirmed by the Senate as principal officers. HHS Secretary Robert F. Kennedy Jr. argues that the current appointment procedures suffice since the Task Force is composed of inferior officers who can be reviewed and fired at-will by the HHS Secretary. This case has wide-ranging implications, from potentially altering the structure of mandated healthcare under the ACA’s insurance to affecting the long-established method by which task forces, advisory bodies, and administrative panels must be appointed.

Questions as Framed for the Court by the Parties

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Issues

In 2010, Congress passed the Patient Protection and Affordable Care Act (“ACA”). The ACA, in part, provides tax credits for insurance premiums to eligible citizens that obtain insurance through “Exchanges,” which are health insurance marketplaces. The IRS interpreted the ACA to permit tax credits to all eligible citizens regardless of whether the Exchange is federally or state-run. In this case, the Supreme Court will have the opportunity to resolve whether the ACA, which grants tax credits to individuals who obtained insurance through state-established Exchanges, also extends those tax credits to federally-established Exchanges. Several Virginia residents contend that the plain text of the ACA shows that Congress only intended for state-established Exchanges receive tax credits and that the Chevron deference is inapplicable because of the unambiguous meaning of the text. The government counters that tax credits are available to “applicable taxpayers”—a status determined independent of the type of Exchange within a citizen’s state—and, also, that the Chevron deference applies because the government’s interpretation avoids creating conflicts within the ACA. This case will profoundly impact the balance of federalism, the separation of power between the legislative and executive branches, and the American healthcare marketplace. 

Questions as Framed for the Court by the Parties

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This case consolidates four lawsuits, together asking the Court to determine if Section 1342 of the Affordable Care Act statutorily obliges Congress to fulfill outstanding payments to insurance companies after Congress failed to appropriate funds for these payments. Section 1342 established a “risk-corridors program,” whereby health insurers and the United States government would share unforeseen costs associated with providing universal healthcare on “health benefit exchanges.” Petitioners argue that Section 1342 statutorily requires the government to make full “payments out” to insurance companies who have suffered a loss—regardless of whether Congress appropriated enough money to cover these losses. Respondent, the United States, counters that Section 1342 merely created a program to oversee “payments out” to health insurers, and even if it does oblige the government to make payments, Congress’s appropriations riders repealed that obligation. The outcome of this case has implications for the separation of powers principles and the future of public-private partnerships.

Questions as Framed for the Court by the Parties

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