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Court of Federal Claims

Recently, a judge at the US Court of Federal Claims declined immediate help to a Lake Oswego, Oregon-based health insurer seeking more than twenty one million dollars in payments from a troubled ACA program. However, the judge thinks that she can rule on if the Affordable Care Act program owes the insurer money.

The judge, Margaret Sweeney, approved some parts of the complaint that was filed by Health Republic Insurance Company and rejected the others. Health Republic was a provider based in Lake Oswego, Oregon, and they started to shut down in part owing to the concerns about the delays in payment of the Affordable Care Act.

In February 2016, Health Republic accused the United States of causing serious financial issues to them and the other insurers, as the government failed to make twenty-two million dollars in ACA program payments owed to it and about five billion dollars to the other insurers in the area for the years 2014 and 2015.

As per the section 1342 of the ACA, the US Department of Health and Human Services will have to provide a Risk Corridor program for the insurers who are selling coverage via the ACA public exchange system in 2014, 2015, and 2016. This program was intended to shield the health insurers from the effects of the new ACA programs and rules by making use of cash from the thriving exchange plan issuers to assist struggling health insurers during the year in which the program came into effect.

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Affordable Care Act

However, the program managers of the Risk Corridor initiative collected only enough money from the exchange plan issuers that performed well in the years 2014 and 2015 to pay almost 16 percent of the amounts that was owed to the struggling issuers for the year 2014. Reports say that the HHS’ program has not paid any money owed to the struggling issuers for the year 2015.

Sweeney concluded that her court does not have subject matter jurisdiction over the request by Health Republic for damages from the failure of the Federal government to offer Risk Corridor program payments or for injunctive or declarative relief. “The court possesses subject matter jurisdiction to entertain plaintiff’s claim that HHS, by failing to make full risk corridor payments for 2014 and 2015, violated section 1342 of the Affordable Care Act and the regulation implementing section 1342’s payment requirements,” Sweeney said.

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