No. 18-1028

Moda Health Plan, Inc. v. United States

Lower Court: Federal Circuit
Docketed: 2019-02-06
Status: Judgment Issued
Type: Paid
Amici (6)Relisted (2) Experienced Counsel
Tags: appropriations appropriations-riders bait-and-switch federal-circuit government-contracts government-obligation health-care health-exchanges health-insurance insurance statutory-commitment statutory-interpretation statutory-promise takings
Key Terms:
SocialSecurity Takings JusticiabilityDoctri
Latest Conference: 2019-06-20 (distributed 2 times)
Related Cases: 18-1023 (Vide) 18-1038 (Vide)
Question Presented (AI Summary)

Whether Congress can evade its unambiguous statutory promise to pay health insurers for losses already incurred simply by enacting appropriations riders restricting the sources of funds available to satisfy the government's obligation

Question Presented (from Petition)

QUESTION PRESENTED To encourage health insurers to offer insurance on newly created health benefit exchanges, and to keep premiums low, the federal government made an unambiguous statutory commitment: If the costs of claims under these new health insurance policies exceeded the premiums charged in the first three years, the government would reimburse insurers a specified percentage of the difference. Numerous health insurers, including petitioners, relied on that promise, joined the exchanges, set their premiums, and incurred significant losses in providing health coverage. Congress later enacted a series of appropriations riders restricting the sources of funds available to the Department of Health and Human Services (“HHS”) to pay insurers what was owed, but never amended the underlying statute. A divided Federal Circuit panel agreed that the government’s initial statutory commitment was unambiguous, but relied on legislative history to hold the appropriations riders had repealed the statutory guarantee. The net effect was a bait-and-switch of staggering dimensions in which the government has paid insurers $12 billion less than what was promised. The question presented is: Whether Congress can evade its unambiguous statutory promise to pay health insurers for losses already incurred simply by enacting appropriations riders restricting the sources of funds available to satisfy the government’s obligation.

Docket Entries

2020-05-29
JUDGMENT ISSUED.
2019-11-05
Record from the U.S.C.A. Federal Circuit is electronic and located on Pacer.
2019-10-25
CIRCULATED
2019-10-23
Record requested from the U.S.C.A. Federal Circuit.
2019-06-17
DISTRIBUTED for Conference of 6/20/2019.
2019-05-28
Reply of petitioners Moda Health Plan, Inc., et al. filed. (Distributed)
2019-05-28
DISTRIBUTED for Conference of 6/13/2019.
2019-04-01
Motion to extend the time to file a response is granted and the time is further extended to and including May 8, 2019.
2019-03-29
Motion to extend the time to file a response from April 8, 2019 to May 8, 2019, submitted to The Clerk.
2019-03-08
Brief amicus curiae of The Association for Community Affiliated Plans filed.
2019-03-08
Brief amicus curiae of Chamber of Commerce of the United States of America filed.
2019-03-08
Brief amici curiae of Highmark Inc., et al. filed.
2019-03-08
Brief amicus curiae of National Association of Insurance Commissioners filed.
2019-03-08
Brief amici curiae of 18 States and the District of Columbia filed.
2019-03-08
Brief amicus curiae of America's Health Insurance Plans filed.
2019-02-27
Motion to extend the time to file a response is granted and the time is extended to and including April 8, 2019.
2019-02-25
Motion to extend the time to file a response from March 8, 2019 to April 8, 2019, submitted to The Clerk.
2019-02-21
Blanket Consent filed by Petitioners, Moda Health Plan, Inc., et al..
2019-02-04
Petition for a writ of certiorari filed. (Response due March 8, 2019)

Attorneys

18 States and the District of Columbia
Benjamin Noah GutmanOffice of the Attorney General of the State of Oregon, Amicus
Benjamin Noah GutmanOffice of the Attorney General of the State of Oregon, Amicus
America's Health Insurance Plans
Pratik Arvind ShahAkin Gump Strauss Hauer & Feld, LLP, Amicus
Pratik Arvind ShahAkin Gump Strauss Hauer & Feld, LLP, Amicus
Blue Cross Blue Shield Association
K. Lee Blalack IIO'Melveny & Myers, LLP, Amicus
K. Lee Blalack IIO'Melveny & Myers, LLP, Amicus
Chamber of Commerce of the United States of America
Paul J. ZidlickySidley Austin LLP, Amicus
Paul J. ZidlickySidley Austin LLP, Amicus
Economists M. Kate Bundorf; Scott Harrington; Michael Chernew; Leemore S. Dafny; Thomas G. McGuire; Mark V. Pauly; Kosali Simon
Andrew H. SchapiroQuinn Emanuel Urquhart & Sullivan, LLP, Amicus
Andrew H. SchapiroQuinn Emanuel Urquhart & Sullivan, LLP, Amicus
Highmark Inc., Blue Cross and Blue Shield of Kansas City, Blue Cross and Blue Shield of Vermont, Blue Cross of Idaho Health Service, Inc., Molina Healthcare of California, Inc., and L.A. Care Health Plan
Lawrence S. SherReed Smith LLP, Amicus
Lawrence S. SherReed Smith LLP, Amicus
Moda Health Plan, Inc., et al.
Paul D. ClementKirkland & Ellis LLP, Petitioner
Paul D. ClementKirkland & Ellis LLP, Petitioner
National Association of Insurance Commissioners
Derek T. TeeterHusch Blackwell LLP, Amicus
Derek T. TeeterHusch Blackwell LLP, Amicus
The Association for Community Affiliated Plans
William Lewis RobertsFaegre Baker Daniels LLP, Amicus
William Lewis RobertsFaegre Baker Daniels LLP, Amicus
United States
Noel J. FranciscoSolicitor General, Respondent
Noel J. FranciscoSolicitor General, Respondent