Court: Failure to provide 2017 CSR payments to insurer violated ACA

Sep 06, 2018 - 03:16 PM

The federal government violated a statutory obligation created by Congress in the Affordable Care Act when it failed to provide Montana Health, an issuer of qualified health plans on the Montana and Idaho health insurance exchanges, its full cost-sharing reduction payments for 2017, a federal judge ruled yesterday. “That obligation was not vitiated by Congress’s failure to appropriate funds for that purpose,” wrote Judge Elaine Kaplan of the U.S. Court of Federal Claims, granting summary judgment to the insurer. The administration last October halted CSR payments to insurers, used to reduce out-of-pocket costs for low-income individuals purchasing coverage through the exchanges, prompting several lawsuits. AHA and others have urged Congress to continue funding the payments to help stabilize the individual health insurance market.  

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