A U.S. Court of Federal Claims ruled the government must pay $214 million to Portland, Ore.-based health insurer Moda Health under the ACA's risk corridors program.
Here are five things to know.
1. Moda Health sought payments owed under the risk corridors program, which was designed to level the financial playing field for payers during the first three years of the ACA's implementation. Under the program, HHS collected payments from insurers with lower than expected claims on the health insurance exchanges and made payments to insurers with higher than expected claims.
2. Moda shouldered losses on its ACA exchange plans during 2014 and 2015 and sought hundreds of millions of dollars in risk corridors payments from the government. To date, CMS has paid 12.6 percent of Moda's risk corridors payments for 2014 and has not issued payments for 2015.
3. In a 40-page judgment, Judge Thomas Wheeler determined the ACA requires annual payments to insurers, and Congress did not design the risk corridors program to be budget-neutral. He concluded the government unlawfully withheld risk corridors payments from Moda and is liable for them.
4. Judge Wheeler wrote "the government made a promise in the risk corridors program that it has yet to fulfill. Today, the court directs the government to fulfill that promise. After all, to say to [Moda], 'The joke is on you. You shouldn't have trusted us,' is hardly worthy of our great government."
5. A number of health insurers sued the federal government for funds they were owed under the program after HHS notified insurers they would receive only 12.6 percent of payment owed for 2014. The risk corridors program, which ran through 2016, fell short by more than $2.5 billion in its first year because of financial losses incurred on the individual market.