Supreme Court seems supportive of a $12-billion claim by insurers who say they covered high-risk patients, then were subject to a 'bait-and-switch.'
The Supreme Court gave a sympathetic hearing Tuesday to health insurers who were promised their losses would be covered if they expanded coverage under Obamacare, only to have the Republican-controlled Congress later refuse to pay.
At issue is a provision of the Affordable Care Act of 2010 that encouraged health insurers to offer coverage at reasonable rates to people who had been denied because of preexisting medical conditions. The law said the government “shall pay” insurers if they lost money by offering this coverage. However, they were required to pay the government if they made extra profits from the high-risk group.But when the coverage began in 2014, the losses for insurers were higher than expected.
“Although we agree with [health insurer] Moda that Section 1342 obligated the government to pay the full amount of risk corridors payments according to the formula it set forth,” the appeals court said, “we hold that the riders on the relevant appropriations effected a suspension of that obligation for each of the relevant years.”During Tuesday’s argument, lawyers clashed over whether a law passed by one Congress could be binding on appropriators of the next.
Justice Brett M. Kavanaugh said Congress often says in a law that funding is subject to a future appropriation. But the Affordable Care Act did not include such a warning, he noted.
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