Maine Community Health Options v. United States (18-1023)

argument 18-1023

Maine Community Health Options v. United States

Supreme Court of the United States 1h 0m 5 speakers 8 chapters transcribed 8 days ago official recording ↗

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What is the core dispute over the government’s “shall‑pay” promise in the risk‑corridor program?

John G. Roberts 0:00

We'll hear argument first this morning in case eighteen ten twenty three, Maine Community Health Options versus United States and the consolidated cases.

Solicitor General Noel J. Francisco 0:08

John G. Roberts 0:09

Clement.

Solicitor General Noel J. Francisco 0:10

Mr Chief Justice, and may it please the court. This case involves a massive government bait and switch and the fundamental question of whether the government has to keep its word after its money-mandating promises have induced reliance. The government suggests that there is no such thing as an enforceable congressional promise, and that even the clearest command to pay money is subject to a caveat that it's subject to appropriations and relying on the government. science, even on clear language, is quote inherently unreasonable. That position is inconsistent with all this Court's cases, including the ones that go the government's way by finding an implied repeal. For in the government's view, there is nothing to repeal.

Solicitor General Noel J. Francisco 0:55

Simply failing to appropriate the money cancels the obligation. The government's position would also make it impossible to accomplish many important government objectives that require a clear and enforceable promise to pay, as this case well illustrates. When Congress made the health benefit exchanges a centerpiece of the Affordable Care Act, it faced a problem. The exchanges depended on the participant of private health insurance companies, and those companies were being asked to insure previously uninsured people on unprecedented terms. The natural reaction of the insurers would have been to charge a substantial premium to account for the uncertainties, but that premium would have worked against the government in two fundamental ways.

Solicitor General Noel J. Francisco 1:39

First, it would have made the policies relatively unaffordable. Contrary to the whole purpose of the Affordable Care Act, and second, the Government would have ended up paying for those heightened premiums through tax subsidies. So the risk corridor programs at issue here was an important component of the Government's solution to the problem. The program depended on a clear and enforceable promise that the government would pay for a portion of any losses incurred by the government. heard by the health insurance companies that step forward. In order for that promise to work, it had to be clear and enforceable. If the government had simply said, we will make these risk corridor payments subject to appropriations, the promise would have made no difference whatsoever.

Solicitor General Noel J. Francisco 2:25

If all the insurance companies were doing was trading the uncertainties about the risk pool for the uncertainties over the funding priorities of future Congresses, they would have gained nothing in the process. So Congress made a clear, money-mandating promise to pay. Pay. Based on that promise, my clients and others got State approved rates to offer policies on the exchanges. After those rates were already set, then HHS adopted its so-called transitional policy, which kept some healthy people off the exchanges, and as the government itself recognized, meant that more insurers would lose more money. HHS said to the insurers, don't worry, we have the risk corridors program in place, and we will cover some of those excess losses as a result of the transitional policy.

Solicitor General Noel J. Francisco 3:17

So the policies went forward, and losses were incurred, and when it became time to pay, the government then started pointing to some ambiguous appropriations riders. But those riders, by their plain terms, did not repeal the obligations of thirteen forty two or even say prospectively that we're going to limit the payments out to the extent of payments in. What if they had been

Samuel A. Alito 3:42

included in the original legislation. If the appropriations uh writers had been included in the original legislation, would that make a difference?

Solicitor General Noel J. Francisco 3:52

Ultimately, I don't think it would make a a difference in the sense that I think it is a little hard to to figure out exactly what that would look for like. And I think the reason you didn't have appropriation riders in the 2010 legislation is because for this part of the policy, the policies wouldn't be offered until 2014, and you really wouldn't be in a position to know whether or not there was an obligation until 2015.