Maine Community Health Options v. United States

Background

Four health-insurance companies that sold plans on the ACA exchanges say they lost money under the temporary Risk Corridors program and that the Government owes them payments under §1342. The program’s formula said profitable plans “shall pay” the Government and unprofitable plans the Government “shall pay.” Many insurers sought reimbursement after the program ran large deficits and Congress later included riders in annual appropriations that limited use of certain funds for Risk Corridors payments. The insurers sued the United States for money damages in the Court of Federal Claims.

Reasoning

The Court addressed three plain questions: did the statute create a payment obligation, did Congress’ appropriations riders repeal that obligation, and could insurers sue for damages. The majority found the statute’s mandatory wording (“shall pay”) created a money-mandating obligation; established precedents show such obligations can be enforced even when appropriations lag. The Court rejected the idea that routine appropriations riders silently repealed the obligation, noting repeals by implication are disfavored and the riders lacked clear repeal language. The Court also held that the insurers may sue under the Tucker Act in the Court of Federal Claims for those unpaid sums.

Real world impact

Insurers who lost money under the three-year program may recover damages through federal claims courts. The Risk Corridors deficit exceeded $12 billion, so the ruling could obligate large federal payments for past marketplace losses. The cases are returned to lower courts for further proceedings to calculate and award specific sums.

Dissents or concurrances

A dissent argued the Court should not infer a broad private right to recover damages, warned about large taxpayer cost, and asked for further briefing and re-argument.