No. 20-1432

United States v. Maine Community Health Options, et al.

Lower Court: Federal Circuit
Docketed: 2021-04-13
Status: Denied
Type: Paid
Experienced Counsel
Tags: affordable-care-act appropriations cost-sharing-reduction cost-sharing-reductions government-liability implied-damages implied-right-of-action premium-tax-credits statutory-interpretation
Key Terms:
SocialSecurity JusticiabilityDoctri
Latest Conference: 2021-06-17
Related Cases: 20-1162 (Vide)
Question Presented (AI Summary)

Whether the court of appeals erred in concluding that Congress intended to afford insurers an implied money-damages remedy as compensation for CSR payments that were not made because Congress declined to appropriate funds to pay them and that could generally be offset under other ACA provisions that insurers invoked to obtain a recovery

Question Presented (OCR Extract)

QUESTION PRESENTED Section 1402 of the Patient Protection and Affordable Care Act (ACA), Pub. L. No. 111-148, 124 Stat. 220, requires insurers to reduce cost sharing (such as deductibles and copayments) for certain individuals who purchase “silver” plans through an ACA Exchange. 42 U.S.C. 18071. “{I]n order to reduce the premiums,” 42 U.S.C. 18082(a)(3), the ACA also directs the government to make advance payments to insurers equal to the value of such cost-sharing reductions (CSR payments), 42 U.S.C. 18082(c)(3). In October 2017, the government ceased making CSR payments to insurers after determining that it lacked any appropriation to pay them. For 2018 and subsequent years, many insurers—including respondents— offset the absence of CSR payments by increasing their silver-plan premiums. By operation of the ACA’s formula, increasing silver-plan premiums also resulted in a substantial increase in premium tax credits that the government pays to insurers on behalf of lower-income individuals. 26 U.S.C. 36B(b)(2)(B). Respondents brought these actions seeking money damages for unpaid CSR payments. The court of appeals held that the government was liable to insurers for unpaid CSR payments but that an insurer’s damages must be offset to account for the additional premium tax credits that the insurer received. The question presented is as follows: Whether the court of appeals erred in concluding that Congress intended to afford insurers an implied moneydamages remedy as compensation for CSR payments that were not made because Congress declined to appropriate funds to pay them and that could generally be offset under other ACA provisions that insurers invoked to obtain a recovery. (I)

Docket Entries

2021-06-21
Petition DENIED.
2021-06-01
DISTRIBUTED for Conference of 6/17/2021.
2021-06-01
Reply of petitioner United States filed. (Distributed)
2021-05-17
Brief of respondents Maine Community Health Options, et al. in opposition filed.
2021-05-07
Motion to extend the time to file a response is granted and the time is extended to and including May 17, 2021.
2021-05-06
Motion to extend the time to file a response from May 13, 2021 to May 17, 2021, submitted to The Clerk.
2021-04-09
Petition for a writ of certiorari filed. (Response due May 13, 2021)

Attorneys

Maine Community Health Options, et al.
Paul D. ClementKirkland & Ellis LLP, Respondent
Paul D. ClementKirkland & Ellis LLP, Respondent
United States
Elizabeth B. PrelogarActing Solicitor General, Petitioner
Elizabeth B. PrelogarActing Solicitor General, Petitioner