Supreme Court declines to hear cost sharing reduction case

Photo: Mike Kline / Getty Images

The Supreme Court will not hear a case for unpaid co-payment reimbursement payments to insurers.

The Supreme Court rejected the Maine Community Health Options and Community Health Choice petition on June 21. This means that court rulings with lower appeals will stand and insurers will receive less reimbursement than they requested.

The appeals court ruled that the government should pay the promised CSRs, but it also implied that the government does not owe the money because insurers are otherwise funded through a practice of raising premiums for silver plans known as “silver loading”. Most consumers stop paying because the premium tax credits are based on silver premiums. The government eventually subsidizes the silver charging of the premiums.

The insurers challenged the Supreme Court to rule that they owe the full CSR payments.

In a letter filed on June 1, the health plans stated that the federal government had failed to meet its payment obligations under the Affordable Care Act.

The ACA requires insurers to provide co-payments to consumers with incomes below 250% of the state poverty level who sign up for silver tier marketplaces. But while the federal government is no longer providing reimbursements, insurers must provide CSRs to eligible consumers who sign up.

“It runs into the billions and goes way beyond this case,” said the plans asking the Supreme Court to review.

WHY THIS IS IMPORTANT

Hundreds of millions, if not billions of dollars, owed to insurers, are at stake, according to Margaret A. Murray, CEO of the Association for Community Affiliated Plans, which filed an amicus briefing in support of insurers.

“As stated in the Amicus letter we filed, these ramifications are particularly significant for smaller community schemes like ACAP members, who are less well equipped to weather market disruptions or absorb losses than national insurance carriers.”

THE BIGGER TREND

Maine Community Health Options and Community Health Choice took the case to the Supreme Court in February after years of back and forth between insurers and the government.

The issue became politicized when members of Congress said they had never approved the funding for CSRs contained in former President Barack Obama’s health bill.

In 2016, District of Columbia Judge Rosemary M. Collyer agreed. The lawsuit was resolved in May 2018, according to Health Affairs, but not before the Trump administration cited Collyer’s ruling in October 2017 to justify a decision to stop CSR payments.

A federal court granted the insurers class action status for the payments. In August 2020, the U.S. Federal Circuit Court of Appeals upheld a 2019 court order calling on the federal government to reimburse insurers for co-payment payments, but limited the amount payable.

ON THE RECORD

Murray said, “ACAP is disappointed with the court’s decision to uphold the Federal Circuit ruling on this case, but for anyone doing business with the federal government.”

Twitter: @SusanJMorse
Email the author: susan.morse@himssmedia.com

source https://dailyhealthynews.ca/supreme-court-declines-to-hear-cost-sharing-reduction-case/