Maine Community Health Options v. United States
Issues
Did Section 1342 of the Affordable Care Act statutorily oblige the government to fulfill all outstanding payments owed to insurance companies under Section 1342’s risk-corridors program, and if so, did Congress’s appropriations riders impliedly repeal that obligation?
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out” to health insurers, and even if it does oblige the government to make payments, Congress’s appropriations riders repealed that obligation.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
(1) Whether—given the “cardinal rule” disfavoring implied repeals, which applies with “especial force” to appropriations acts and requires that repeal not to be found unless the later enactment is “irreconcilable” with the former—an appropriations rider whose text bars the agency’s use of certain funds to pay a statutory obligation, but does not repeal or amend the statutory obligation, and is thus not inconsistent with it, can nonetheless be held to impliedly repeal the obligation by elevating the perceived “intent” of the rider (drawn from unilluminating legislative history) above its text, and the text of the underlying statute; and (2) whether—when the federal government has an unambiguous statutory payment obligation, under a program involving reciprocal commitments by the government and a private company participating in the program—the presumption against retroactivity applies to the interpretation of an appropriations rider that is claimed to have impliedly repealed the government’s obligation.
In 2010, Congress passed the Patient Protection and Affordable Care Act (“ACA”), which, among other healthcare reforms, created virtual marketplaces, called health benefit exchanges (“Exchanges”), that allowed individuals and groups to purchase healthcare coverage from one centralized forum. Moda Health Plan, Inc. v.
Edited by
Additional Resources
- Adam Lidgett, Congress Chose to Block $12B in ACA Funds, Justices Told, Law 360 (Oct. 23, 2019).
- Shelby Livingston, Supreme Court to Hear Cases Over ACA Risk-Corridor Funds, Modern Healthcare (June 24, 2019).
- Debra Cassens Weiss, Supreme Court to Consider Cases Accusing US of Shorting Health Insurers $12B in Promised Payments, ABA Journal (June 24, 2019).