Aside from Texas v. Azar and similar litigation in Maryland concerning the constitutionality of the ACA, several other lawsuits are targeting key aspects of the law this year, according to Health Affairs.
Here are 10 notes on pieces of litigation concerning the ACA's cost-sharing reduction payments, risk adjustment payments and short-term health plans.
1. Many lawsuits have been filed over cost-sharing reduction payments since 2014. CSR payments help insurers subsidize the cost of covering low-income Americans.
2. Several health insurers filed separate lawsuits after the Trump administration ended CSR payments in 2017. Maine Community Health Options and Sanford Health Plan won lawsuits over the unpaid CSR payments. However, the federal government plans to appeal both cases to the Federal Circuit. The cases will likely be consolidated on appeal, according to Health Affairs.
3. Additionally, several lawsuits concerning CSR payments have been stayed pending a decision on Moda Health Plan's case from the Federal Circuit. Moda Health Plan is a health insurer in Portland, Ore.
4. Other proceeding lawsuits on the CSR payments, brought by Health Alliance Medical Plans and Blue Cross Blue Shield of Vermont, are awaiting another hearing or briefing.
5. Guidewell Mutual Holding Corp., which includes Blue Cross and Blue Shield of Florida, Florida Health Care Plan and Health Options, filed a lawsuit over $223 million in unpaid CSRs in November 2018.
6. Another health insurer, Harvard Pilgrim Health Care in Massachusetts, also filed a lawsuit in November of last year concerning unpaid CSRs from 2017.
7. A challenge filed by Molina Healthcare over $160 million in CSR payments remains stayed until a nonappealable, final judgement is issued on the aforementioned Moda Health Plan case.
8. New Mexico Health Connections filed a lawsuit in August against a final rule on 2017 risk adjustment methodology. The risk adjustment program was established under the ACA to encourage insurers to participate in the exchanges and accept all customers without charging more for patients in need of substantial medical services.
9. In addition to health insurer lawsuits, 12 Democratic attorneys general filed a lawsuit in July 2018 challenging CMS' final rule to expand association health plan access. The federal government asked the court to dismiss the lawsuit.
10. Lastly, a lawsuit concerning the expansion of short-term health plans was filed in September 2018 by a coalition of consumer advocates and safety-net health plans.
For the full Health Affairs analysis, click here.
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