District Judge Says Obamacare Reimbursements are Invalid

Steven D. Schwinn, John Marshall Law School

Judge Rosemary Collyer (D.D.C.) ruled today that the Obama Administration spent money on reimbursements to insurers on the ACA exchanges without a valid congressional appropriation. Judge Collyer enjoined any further reimbursements to insurers until a valid appropriation is in place, but she stayed that injunction pending appeal.

Because of the stay, the ruling will have no immediate effect on government subsidies to insurers (and thus no immediate effect on the overall ACA, reductions in cost-sharing for certain purchasers on exchanges, or any other feature of the Act). But if Judge Collyer's ruling is upheld on appeal, and if Congress fails to specifically appropriate funds for Section 1402 reimbursements, or if the stay is lifted, this could deal a significant blow to the ACA. That's because the Act would require exchange insurers to provide a cost-sharing break to certain purchasers on the exchange, but the government wouldn't be able to reimburse the insurers for those costs, as the Act assumes. This could drive up costs, or drive insurers off the exchanges, or both--in any event, undermining the goals of the ACA.

The case involves Section 1402 of the ACA, which provides reimbursements to insurers on the ACA exchanges. Those reimbursements are designed to off-set reductions in deductibles, co-pays, and other cost-sharing expenses that the ACA requires exchange insurers to provide to lower-income insurance purchasers on an exchange. In other words, the ACA requires exchange insurers to cut cost-sharing costs for certain purchasers; and Section 1402 authorizes the government to reimburse insurers for those cuts.

But Congress didn't specifically appropriate funding for Section 1402. The administration nevertheless provided reimbursements on the theories that 1402 reimbursements are part of the integrated package that makes the ACA work, and that 1402 appropriations are covered in appropriations for other provisions in the Act.

Judge Collyer rejected these arguments. In particular, she wrote that Section 1402 is separate and distinct from other portions of the Act and requires its own, specific appropriation--not an inferred appropriation, based on a holistic reading of the Act, or based on appropriations for other features of the Act. (Behind these legal arguments is the idea that everyone understood that spending for Section 1402 reimbursements would be covered by appropriations for other portions of the Act. But "everyone understood" doesn't get very far in court.)

Moreover, she said that the government's attempts to leverage King v. Burwell to argue that Section 1402 funding is a necessary part of an integrated ACA fall flat:

This case is fundamentally different from King v. Burwell. There, the phrase "established by the State" . . . became "not so clear" when it was "read in context." . . . Simply put, the statute could not function if interpreted literally; it had to be saved from itself. . . .

The problem the Secretaries have tried to solve here is very different: it is a failure to appropriate, not a failure in drafting. Congress's subsequent inaction, not the text of the ACA, is what prompts the Secretaries to force the elephant into the mousehole.

Judge Collyer's ruling is obvious not the end of this matter: the government will surely appeal. In the meantime, her stay (alone) should allow government continued spending on insurer reimbursements, and thus (alone) won't have any significant impact on the ACA.

Judge Collyer earlier ruled that the House of Representatives had standing to bring this case, but that it lacked standing to challenge another administration act, delay of time when employers had to provide minimum health insurance to employees.