About | HeinOnline Law Journal Library | HeinOnline Law Journal Library | HeinOnline
LOG IN
LOG IN

1 1 (July 16, 2020)

handle is hein.crs/govdazl0001 and id is 1 raw text is: Resarh Service Ripple Effects: Assessing Impacts of the Supreme Court's Risk Corridors Decision July 16, 2020 Although most eyes tracking Affordable Care Act (ACA) litigation may be drawn to Califbrnia v. Texas during the Supreme Court's upcoming term, the Court handed down an ACA decision this past term that may have numerous ripple effects in other ACA cases and programs. Specifically, in Maine Commun ily tlealth Options v. Unted SIates, the Court considered whether the United States is obligated, under the ternporary Risk Corridors Program, to make payments to health insurance providers who offered coverage at a loss in the ACA's individual and small group markets. Though the Department of Health and Human Services (HHS) calculated insurer payments for the 2014, 2015, and 2016 program years, HHS paid a fraction of that amount. Limitations in HHS's annual appropriations acts prevented use of annually appropriated funds to make payment in full. Despite this lack of available appropriations, the Court held that the United States incurred obligations to insurers under the Risk Corridors statute for which insurers could obtain payment through litigation. This ruling is important in its own right for what it teaches about private parties' ability to sue the federal government to recover on statutory obligations, even when Congress has not provided for payment of such obligations outside of litigation. Notwithstanding the affirmance of this right, questions of the government's full liability for Risk Corridor payments could potentially linger for several years. Separately, the Court's decision may affect insurer claims for payment under the ACA's cost-sharing reduction (CSR) program, which compensates insurers to help cover the cost of required reductions in an insured's cost sharing. Finally, HHS and insurers may need to consider how Risk Corridor settlements or judgments should be treated under the ACA's medical loss ratio calculation rules. This Sidebar examines each of these potential ripple effects in turn and notes considerations for Congress. Remaining Risk Corridors Program Litigation The claims resolved in Maine Community Health Options itself represented a relatively small portion of the pending claims against the United States for failing to make payments under the Risk Corridors Program. By the government's count, insurers have brought more than 64 other cases asserting similar Risk Corridor claims. The Court's decision will likely spur judgments or settlements in these other cases, likely drawing billions of dollars from the U.S. Treasury in the process. But the full extent of the government's liability for unmet Risk Corridor payments may not be known for several years. Congressional Research Service https://crsreports.congress.gov LSB10519 CRS LegaM Sideba Prepaimed for Mernbei-s and Comrm ttees of Conress ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

What Is HeinOnline?

HeinOnline is a subscription-based resource containing thousands of academic and legal journals from inception; complete coverage of government documents such as U.S. Statutes at Large, U.S. Code, Federal Register, Code of Federal Regulations, U.S. Reports, and much more. Documents are image-based, fully searchable PDFs with the authority of print combined with the accessibility of a user-friendly and powerful database. For more information, request a quote or trial for your organization below.



Short-term subscription options include 24 hours, 48 hours, or 1 week to HeinOnline.

Purchase Access

Contact us for annual subscription options:

Contact Us

Already a HeinOnline Subscriber?

Log In

profiles profiles most