Supreme Court Rules in Favor of Health Insurers Under ACA Program
April 29, 2020 | Affordable Care Act | Litigation | Private InsurersOn April 27, the U.S. Supreme Court ruled in favor of commercial health insurers that were seeking $12 billion under the Affordable Care Act’s risk corridor program, acknowledging that the ACA “obligated the government to pay the full amount of risk corridor payments.”
The ACA established the risk corridor program to mitigate the risks assumed by insurance companies participating in the ACA’s health insurance exchanges, or marketplaces, without knowing the consumer demand for their affordably priced policies. In consideration for their participation, under the program the federal government would limit the insurers’ gains and losses from their policies sold in the marketplaces from 2014 through 2016. Specifically, the companies would pay a portion of their profits to the federal government if their premiums exceeded their claimed medical expenses; however, if premiums fell short of medical expenses, the companies would be entitled to receive payments from the government.
Congress subsequently enacted a series of appropriation riders that banned the promised payments under the risk corridor program. Early participants in the ACA’s marketplaces were hurt the most, as they incurred significant losses. As a result, Moda Health, Maine Community Health Options, Land of Lincoln Mutual Insurance Co. and Blue Cross Blue Shield of North Carolina sued the federal government for the payments owed to them under the program.
The Court stated that its decision reflects “a principle as old as the nation itself: The government should honor its obligations.” Congress could have limited the government’s financial exposure under this program, as it did with other provisions of the ACA, but it did not do so. The Court added, “the plain terms of the risk corridor provision created an obligation neither contingent on nor limited by the availability of appropriations or other funds.” In light of the Court’s decision, billions of taxpayer dollars will have to be paid to the plaintiff insurance companies even though Congress has declined to appropriate money to fund the risk corridor program.
MORE NEWS ON Affordable Care Act
The U.S. Department of Justice (DOJ) announced on October 29 that Medtronic USA Inc. agreed to pay $8.1 million to...
Read MoreThe U.S. District Court for the Eastern District of New York has blocked the U.S. Department of Health and Human...
Read MoreOn June 23, the U.S. District Court for the District of Columbia ruled against the American Hospital Association and other...
Read More- ACOs
- Affordable Care Act
- Antitrust
- Behavioral Health
- Cannabis
- Cybersecurity
- Electronic Health Records
- Employer/Employee
- False Claims Act
- FDA
- Fraud and Abuse
- HIPAA
- Home Health
- Hospitals
- Legislation and Public Policy
- Litigation
- Medical Devices and Wearables
- Medicare and Medicaid
- Nursing Homes
- Pharmaceuticals
- Private Insurers
- Tax/IRS
- Telehealth
January 2021 December 2020 November 2020 October 2020 September 2020 August 2020 July 2020 June 2020 May 2020 April 2020 March 2020 February 2020 January 2020 December 2019 November 2019 October 2019 September 2019 August 2019 July 2019 June 2019 May 2019 April 2019 March 2019 February 2019 January 2019 December 2018 November 2018 October 2018
- ACOs
- Affordable Care Act
- Antitrust
- Behavioral Health
- Cannabis
- Cybersecurity
- Electronic Health Records
- Employer/Employee
- False Claims Act
- FDA
- Fraud and Abuse
- HIPAA
- Home Health
- Hospitals
- Legislation and Public Policy
- Litigation
- Medical Devices and Wearables
- Medicare and Medicaid
- Nursing Homes
- Pharmaceuticals
- Private Insurers
- Tax/IRS
- Telehealth
- Jennifer Abreu
- Christopher D. Acosta
- Brian R. Ade
- Ashley (Osadon) Algazi
- Mark N. Antar
- Patrick E. Antonikowski
- Adam J. Augustyn
- Steven J. Auletta
- Michael A.L. Balboni
- Khoren Bandazian
- Timothy J. Bang
- Brian L. Bank
- Samantha R. Barbere
- Angelica M. Barcsansky
- Todd Belous
- Bruce A. Bendix
- Yonatan Bernstein
- Christina M. Bezas
- Michelle A. Bholan
- Merril S. Biscone
- Anthony Bjelke
- Stuart M. Bodoff
- J’Naia L. Boyd
- Jonathan B. Bruno
- Jacqueline (Mecchella) Bushwack
- John P. Campana
- Michael C. Cannata
- Michele Chavez
- Margarita Christoforou
- Brian S. Conneely
- William Cornachio
- Michael J. Cunningham
- Catalina E. De La Hoz
- Nancy A. Del Pizzo
- Thomas V. DeMarco
- Janice J. DiGennaro
- Christine DiGregorio
- Cassandra Rivais DiNova
- John K. Diviney
- Alan C. Eagle
- Glenn H. Egor
- Scott A. Eisenmesser
- Joanne M. Engeldrum
- Harvey S. Epstein
- Eric D. Fader
- Ade A. Famojuro
- Brian L. Feld
- Scott L. Feuer
- James R. Finn
- Kaitlyn E. Flynn
- Randi Forbes
- Matthew D. Fox
- Richard A. Frankel
- Daniel E. Furshpan
- Avigael C. Fyman
- Jenna Z. Gabay
- Max Gershenoff
- David Gise
- Erez Glambosky
- Ryan Goldberg
- Jeffrey P. Gorak
- Stuart I. Gordon
- Paul Gorfinkel
- Sean Gorton
- Jeffrey S. Greener
- Jamie H. Greenwood
- David M. Grill
- Keith S. Grover
- Walter J. Gumersell
- Jason B. Gurdus
- Amanda Gurman
- Lawrence S. Han
- Tamika Hardy
- Michael J. Heller
- Steven T. Henesy
- Katherine A. Heptig
- Claudia Hinrichsen
- Frank Holahan
- Jeremy B. Honig
- Robert Hussar
- Deborah M. Isaacson
- Robert H. Iseman
- Frank P. Izzo
- B. Edward Jaffe
- Ada (Kozicz) Janocinska
- Michael J. Jones
- Geoffrey R. Kaiser
- Priscilla D. Kam
- Gene Y. Kang
- George D. Kappus
- Jay D. Kenigsberg
- Robert C. Kern, Jr.
- Donald Kernisant Jr.
- Cheryl F. Korman
- Yaron J. Kornblum
- Michael A. Kotula
- Evan H. Krinick
- Christopher J. Kutner
- James P. Lagios
- Matthew A. Lampert
- Marie A. Landsman
- Carol A. Lastorino
- Stella Lellos
- David P. Leno
- Alexander Lev
- Barry I. Levy
- Lawrence A. Levy
- Shari Claire Lewis
- David Lobl
- Paul V. Majkowski
- Benjamin P. Malerba
- Robert A. Maloney
- Christopher Mango
- Greg E. Mann
- Henry M. Mascia
- Hannah McCuiston
- John M. McFaul
- Peter P. McNamara
- Melissa D. Medilien
- Matthew B. Meisel
- Douglas E. Menikheim
- Howard M. Merkrebs
- Jamie (Eliassaint) Milfort
- Blythe C. Miller
- Gregory D. Miller
- Siobhain P. Minarovich
- Frank M. Misiti
- Michael C. Mulè
- Laura J. Mulholland
- John P. Mulvaney
- Kenneth C. Murphy
- Anne M. Murray
- Philip Nash
- Kenneth A. Novikoff
- Patrick R. O`Mea
- Colleen A. O’Neil
- Julie Ovicher
- John Panagopoulos
- Alexander G. Pappas
- Ana Parikh
- Janine L. Peress
- Albert W. Petraglia
- Jenna M. Pettograsso
- Justin M. Piccione
- Vincent J. Pontrello
- Lisa Bordoff Procopio
- John F. Queenan
- Evan Rabinowitz
- Frank Raia
- David E. Richman
- Michele R. Rita
- Pia E. Riverso
- John L. Rivkin
- Leonard L. Rivkin
- John J. Robertelli
- Jason M. Romeo
- Joanna B. Rosenblatt
- Burton R. Ross
- Michael R. Rudick
- Jeffrey P. Rust
- Alan S. Rutkin
- Andrea C. Sacks
- Eric Santos
- Keegan B. Sapp
- William M. Savino
- Evan R. Schieber
- Brian S. Schlosser
- Michael Schnepper
- Thomas P. Schulz
- Garin Scollan
- Steven Shapiro
- Wendy Hoey Sheinberg
- Joshua D. Sibble
- Amy L. Silver
- Sean N. Simensky
- Michael A. Sirignano
- Stephen J. Smirti, Jr.
- Joshua D. Smith
- Joseph N. Salomon
- Karen E. Sosler
- Matthew V. Spero
- Eric S. Strober
- Joshua M. Tare
- Stanley J. Tartaglia, Jr.
- Frank P. Tiscione
- Norman L. Tolle
- Alexandria E. Tomanelli
- Michael A. Troisi
- Robert Tugander
- Michael J. Twersky
- Marc S. Ullman
- Frank A. Valverde
- Michael Vanunu
- Michael P. Versichelli
- Michelle Vizzi
- Stephen B. Weissman
- Michael P. Welch
- Amy S. Wiedmann
- David S. Wilck
- Andrew L. Williams
- Stephanie R. Yafeh
- Steven M. Zuckermann
- Alexander Zugaro
- Rivkin Rounds Staff
- Author Test