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Health Care Policy and Law
September 14, 2020

The Affordable Care Act Returns to the Supreme Court: Maine Community Health Options v United States

Author Affiliations
  • 1Department of Public Health & Community Medicine, Tufts University School of Medicine, Boston, Massachusetts
  • 2Deputy Editor, JAMA
JAMA Intern Med. Published online September 14, 2020. doi:10.1001/jamainternmed.2020.3549

Since its passage a decade ago, the Affordable Care Act (ACA)1 has been the subject of 5 challenges in the US Supreme Court, making it one of the most highly litigated health care statutes ever before the high court. On April 27, 2020, the Court issued its decision in Maine Community Health Options v United States, consolidating cases from 4 health insurance companies that offered new insurance plans on the insurance benefit exchanges in the early days of the ACA.2 Holding that the federal government must make good on an ACA provision to reimburse insurance companies for billions of dollars of ACA losses—funds impliedly promised but never thereafter actually appropriated by Congress—the Court’s decision may have significant impact on the government’s obligation to stand by time-sensitive legislation that commits government funding.

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    2 Comments for this article
    Universal Coverage
    Eric Stein, MD | Main Line Health, Emeritus
    The debt incurred by insurers whose expenses are not covered by premiums occurs because of the dearth of young, mostly health enrolled participants in place of the sickest members of the population signing up for coverage. Universal health care would certainly take care of this inequity.

    Risk Corridor
    Bill H, Masters | Healthcare Supply Manufacturing
    Only Congress can appropriate funds as reinforced by a letter to Senator Jeff Sessions from the GAO; however, that same letter stated specifically , funds could be transferred from other programs to provide the funds.

    The CBO had rated the Risk Corridor Program as Deficit/Revenue neutral. In other words greater than 3% would be great enough to fund those companies who losses exceeded 3%.

    What took place here was Congressional Representatives Fred Upton and Jack Kingston inserted Section 227 in a bill passed in December 2014 preventing HHS from transferring funding to the Risk Corridor

    "The government relies on the appropriations process as a final check on the wisdom of legislative initiatives with uncertain price tags. However, in the case of the Risk Corridors program, the Republican administration manipulated the appropriations process to subvert a program to assist the uninsured that had been passed into law by the previous Democratic administration."

    It still could have been fixed; but, the Republican afterwards refused to do so. Hence the issue of insurers withdrawing, Coops going bankrupt, people losing their policies, and premiums to increase. The Risk Corridor program was put in place so as to cover the "dearth" of funding through profits > 3% and a transfer of initial seed money for the fund.