Maine Community Health Options v. U.S.
Maine Community Health Options v. U.S. (U.S. Supreme Court, April 27, 2020): The Supreme Court ordered the federal Department of Health and Human Services (HHS) to pay health insurers for losses under a now-defunct provision of the Affordable Care Act (ACA). From 2014 through 2016, the ACA contained a so-called “risk corridor” provision requiring insurers to pay excess profits to HHS while mandating HHS cover losses of insurers that participated in the health benefit exchanges. Because losses far exceeded profits, the provision resulted in a $12 billion deficit for HHS. During these years, Congress legislatively prohibited HHS from using the funds to pay the insurers. Several insurers sued to recover monies owed, losing in multiple circuit courts of appeals. The Supreme Court overturned those decisions, finding that HHS’ obligation to pay was not repealed by subsequent Congressional appropriation riders. Read the decision here.
View all cases in the Judicial Trends in Public Health – May 1, 2020.