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June 27, 2019

Supreme Court to Hear ACA Risk Corridor Payment Case

SCOTUS has granted certiorari and will hear several cases brought by co-ops and managed care entities related to the risk corridor payments that were authorized by Congress but never funded. The payments were only authorized for three years for the health plans, but virtually nothing was paid under the ACA program by those plans on the exchanges.  Further, additional funds were not allocated by Congress. Despite the rather clear statement by Congress in the ACA that these amounts were “authorized,” it was equally clear that the ACA was to be budget neutral and that the payments were to be funded by payments into the system – something that didn’t happen. Several courts have heard arguments on these claims to date and the US Court of Appeals for the Federal Circuit previously ruled that the Administration was not required to pay the amounts “owed” because there was no fund from which to pay the amounts. This will be an eagerly awaited decision by many for several reasons.