The Trump administration and the House of Representatives are asking for a hold on a case over Affordable Care Act payments that has the potential to test the boundaries between the branches of government.
At issue is not just whether the executive branch had unconstitutionally funded certain ACA payments to insurers, but the limits on government power when it comes to appropriations.
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On January 3, 2017, Judge Margaret Sweeney of the United States Court of Claims certified Health Republic Insurance Company v. United States as a class action. This is one of more than a dozen cases that have been brought by insurers in the Court of Claims challenging the failure of the government to pay marketplace insurers amounts that they claim were due to them under the ACA’s risk corridor program. The class includes:
All persons or entities offering Qualified Health Plans under the Patient Protection and Affordable Care Act in the 2014 and 2015 benefit years, and whose allowable costs in either the 2014 or 2015 benefit years, as calculated by the Centers for Medicare and Medicaid Services, were more than 103 percent of their target.
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On December 28, 2016, two shots were filed in quick succession in the battle over the cost-sharing reduction (CSR) payments, followed on January 29 by an order from the court. The House of Representatives has challenged the CSR payments (which reimburse insurers for reducing cost sharing for low-income marketplace enrollees) in House v. Burwell, claiming that the payments are illegal because they were never appropriated. The lower court ruled for the House, but the Obama administration appealed, arguing that money had been appropriated and that the payments were legal. With the election of Donald Trump, the House asked for a stay of the litigation, suggesting to the court that it might be able to settle the case with the Trump administration. The court stayed the appeal until late February.
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House Republicans are wading into the heated legal battle between the White House and several insurers that claim they are owed money under ObamaCare.
The House GOP announced Friday it has filed a brief in a major ObamaCare lawsuit that involves a multibillion-dollar shortfall in a fund intended to cushion health insurers from financial losses under the law.
The $5 billion class-action lawsuit was filed by the now-shuttered insurance company called Health Republic of Oregon. It is one of about a dozen companies that have sued over the still-delayed payments, which they say crippled their businesses.
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Last week, the comptroller general — the government’s chief accountability officer — issued an official statement that the administration has been sending unlawful payments to insurance companies through the ACA’s reinsurance program. These payments have totaled $3 billion thus far and have forced taxpayers to finance a larger part of insurers’ most expensive enrollees’ claims.
The U.S. House of Representatives filed suit against the administration for unlawful payments through another ACA program. These payments are to insurers for them to make plans more attractive by reducing enrollees’ deductibles and cost-sharing amounts. Congress never appropriated funds, yet the administration has paid insurers at least $10 billion through this program thus far.
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Republicans in Congress are plotting ways to block the Obama administration from paying insurance companies hundreds of millions of dollars as part of an ObamaCare program.
GOP lawmakers say they are looking at “a dozen” options — including a possible provision in the year-end spending bill — to prevent the administration from using an obscure fund within the Treasury Department to pay out massive settlements to insurers.
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The Obama administration is seeking to toss out a pair of high-profile healthcare lawsuits in which insurers claim they are owed millions of dollars under the Affordable Care Act.
The two insurers, Moda Healthcare and BlueCross BlueShield of North Carolina, have sued the federal government over a combined $338 million in ObamaCare payments they argue are overdue.
The Justice Department filed motions to dismiss both lawsuits on Friday, arguing that the federal government isn’t responsible for those payments at all.
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Congressional Republicans are warning the Obama administration not to settle with insurers that have sued the government over an Affordable Care Act program to compensate them for losses under the law, saying such a move would bypass spending limits set by Congress.
Forty-six House Republicans signed a letter sent Thursday to Health and Human Services Secretary Sylvia Mathews Burwell saying they oppose any settlements and could sue the administration to block them.
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New York has revolted against a critical component of the Affordable Care Act: RiskAdjustment. If its revolt survives an almost certain legal challenge, a number of states are likely to double down on New York’s actions and remove one of the few remaining fingers holding Obamacare on to a cliff.
Acting under direction of its new Superintendant of Financial Services, Maria Vullo, New York has joined the chorus of those familiar with the program in contending that the federal Risk Adjustment program is backfiring. Critics say the program transfers too much money amongst insurers and is actually destabilizing the market. New York is the first state, however, to put money behind the critique.
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The Obama administration proposed this week new rules for its Risk Adjustment program, a critical component of the Affordable Care Act. There are actually some better-late-than-never parts of the proposal. Most notably the new rules will try to compensate for the extra expense insurers incur when people exploit ACA regulatory and enforcement weaknesses to time their insurance purchases to cover only expensive medical emergencies.
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