Health Insurance Groups Call For Re-Hearing On ACA Payments

Two leading health insurance trade associations--the Association for Community Affiliated Plans (ACAP) and the Alliance of Community Health Plans (ACHP)--today filed a joint amici curiae brief calling for a re-hearing of the appeal of Moda Health Plan v. United States in the U.S. Court of Appeals for the Federal Circuit.

The case centers on payments to health plans mandated under the Affordable Care Act's 'risk corridor' program, which was intended to mitigate the financial risk borne by health plans entering Health Insurance Marketplaces. Congress passed appropriations riders barring the full funding of the risk corridor program, which left many health plans, including Moda, with the unplanned expense of unpaid government debt.

ACAP and ACHP member health plans are owed, collectively, nearly $2 billion under the risk corridor program.

While the judge found for Moda Health Plan in the U.S. Court of Federal Claims, the decision was reversed on appeal. The brief filed today requests a full hearing en banc in the Court of Appeals.

"Insurers made the decision to enter the Marketplaces with the understanding that risk corridor payments would occur as they are laid out in black and white in the text of the Affordable Care Act," said ACAP CEO Margaret A. Murray. "While our plans are expert in assessing medical risk, they should not also be expected to price in the political risk that Congress would use appropriations riders as a back-door effort to effectively repeal risk corridors."

"ACHP plans are dedicated to providing high-quality affordable coverage to the people who need it most. Risk corridor payments supported that effort backstopping every decision our plans made in the marketplace," said Ceci Connolly, ACHP President and CEO. "Our plans need certainty in the market, to get back to the business of improving the health of their communities, not fretting over the next shock wave to come out of Washington. It's critical that Congress fulfill its promise and fund the risk corridor program."

"If the panel's ruling stands," reads the brief, "this case will become a cautionary tale against relying on government promises of payment--even those enshrined in the U.S. Code."

The amici curiae brief, prepared by attorneys at Faegre Baker Daniels, is available here (https://www.communityplans.net/wp-content/uploads/2018/08/2018-08-13_Brief_of_Amici_Curiae_ACAP_and_ACHP_in_Support_of_Rehearing_MODA.pdf).