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Supreme Court Rules in Favor of Health Plans in Landmark $13 Billion Affordable Care Act Case

By Steve McBrady, Daniel W. Wolff, Clifton Elgarten, Jacinta Alves, A. Xavier Baker, Skye Mathieson & Charles Baek
April 28, 2020
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On April 27, the U.S. Supreme Court issued a decision in Maine Cmty. Health Options et al v. United States, ruling in favor of Maine and companion insurers in the long running Affordable Care Act §1342 “risk corridors” litigation, and confirming the government’s obligation to pay insurers approximately $13 billion for their work related to the ACA. Under the risk corridors program, the government and the health plans shared risk during the first three years of the ACA exchanges, and had reciprocal statutory payment obligations; however, after the health plans performed, the government refused to make full payment, arguing that Congress’ refusal to appropriate funds vitiated the government’s payment obligation. Reversing the Federal Circuit, the Supreme Court held that the statute contained an unambiguous payment mandate, which was not repealed or otherwise suspended by Congress’ failure to make appropriations available. While a failure to appropriate funds prevents agencies from making the payment, the failure does not relieve the United States of its obligation to pay. Speaking for the majority, Justice Sonia Sotomayor wrote: “These holdings reflect a principle as old as the Nation itself: The Government should honor its obligations. Soon after ratification, Alexander Hamilton stressed this insight as a cornerstone of fiscal policy. ‘States,’ he wrote, ‘who observe their engagements . . . are respected and trusted: while the reverse is the fate of those . . . who pursue an opposite conduct.’” C&M partner Steve McBrady called the decision “important” noting that it “cements bedrock principles of fairness into money mandating statute jurisprudence.” Crowell & Moring represented Maine Community Health Options.

Photo of Steve McBrady Steve McBrady
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Photo of Daniel W. Wolff Daniel W. Wolff
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Photo of Clifton Elgarten Clifton Elgarten
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Photo of Jacinta Alves Jacinta Alves
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Photo of A. Xavier Baker A. Xavier Baker

Xavier Baker is a partner in Crowell & Moring’s Health Care Group and is located in the Washington, D.C. office. He advises clients on health care insurance and managed care regulations, investigations, transactions, and litigation. He counsels national and regional health insurers, pharmacy…

Xavier Baker is a partner in Crowell & Moring’s Health Care Group and is located in the Washington, D.C. office. He advises clients on health care insurance and managed care regulations, investigations, transactions, and litigation. He counsels national and regional health insurers, pharmacy benefit managers, care coordination organizations, and other specialty health care service providers and trade associations on complex regulatory issues.

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Photo of Skye Mathieson Skye Mathieson
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Photo of Charles Baek Charles Baek
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  • Posted in:
    Administrative, Corporate Compliance
  • Blog:
    Government Contracts Legal Forum
  • Organization:
    Crowell & Moring LLP
  • Article: View Original Source

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