On Friday a case was filed in the United States Court of Claims by Alliant Health with the United States as defendant. The case concerns the provisions of the Affordable Care Act (ACA) regarding the reimbursement of health plans for certain discounts made to applicants.
The ACA imposed certain obligations on the federal government to help incentivize the participation of private insurers, stabilize premiums, and induce the uninsured to purchase health insurance coverage. The complaint explained that the ACA classified different plans to participate in the marketplace, it created for types of plan: Bronze, which provides the minimum coverage under the ACA;Silver, which is the preferred standard coverage under the ACA; Gold, which provides benefits beyond the standard coverage, and Platinum, which provides benefits beyond the Gold level of coverage.
While all plans are discounted, the Silver plan was specifically required to be discounted to encourage participants to receive the standard coverage, the complaint exaplained. Under 42 U.S.C. § 18071, “An issuer of a qualified health plan making reductions under this subsection shall notify the Secretary of such reductions and the Secretary shall make periodic and timely payments to the issuer equal to the value of the reductions.”.
In 2017, the HHS Acting Secretary Eric Hargan ordered that the payments be stopped, questioning the authority to make the appropriations to make the payments, the complaint alleged. The issue was then litigated in court in several cases, which were decided in favor of the insurance companies. The Supreme Court declined to hear the case as well.
The current case was brought because, while the government has declined to make specific appropriations to pay the cost saving reductions, the duty to pay them remains, according to Alliant.
Alliant is suing for violations of statutory and regulatory mandates, and breach of contract. Alliant is represented by Morris, Manning & Martin LLP.