Association of American Physicians & Surgeons, Inc. v. Sebelius
901 F. Supp. 2d 19
D.D.C.2012Background
- Plaintiffs AAPS and ANH-USA filed a six-count complaint challenging (i) three SSA POMS provisions linking Social Security retirement benefits to Medicare Part A, (ii) ACA employer and individual health insurance mandates, (iii) CMS/IFR and Change Requests 6417/6421 mandating NPIs and PECOS enrollment/opt-out for referrals under Medicare Part B, and (iv) fiduciary/equitable duties claims against HHS and SSA officials.
- Defendants moved to dismiss for lack of jurisdiction and failure to state a claim; the court stayed proceedings pending related appeals and review.
- Decisions in Hall v. Sebelius (D.C. Cir.) and NFIB v. Sebelius (Supreme Court) upheld challenged POMS provisions and the individual mandate, respectively.
- The stay was lifted; the court granted dismissal, finding standing lacking for some counts and failure to state claims for others.
- The court dismissed Counts I, V, VI and portions of Count IV for standing; Counts II–III and remainder of Count IV failed to state a claim; overall dismissal entered.
- This memorandum presents the court’s reasons for subject matter jurisdiction and failure to state a claim.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Standing to challenge POMS provisions | AAPS/ANH argue plaintiffs’ members suffer concrete injuries | Defendants contend lack of concrete injury from mere entitlement | Counts I and associated claims lacking standing; dismissed |
| Constitutional challenges to ACA employer/individual mandates | Mandates violate Constitution (various provisions) | NFIB decision supports Congress’s taxing power; mandates constitutional | Counts II and III dismissed for lack of stateable claim; upheld by controlling authority |
| Validity and scope of Count IV (NPI/PECOS/IFR) | Actions exceed statutory authority or lack notice-and-comment | Actions authorized and properly promulgated; some claims dismissed for lack of standing | Parts of Count IV with standing addressed; remaining claims dismissed for lack of redressability/merits |
| Standing for Counts V–VI (fiduciary/equitable duties) | Allege direct/imminent injury to Medicare/Social Security solvency | Injury too generalized/abstract appears to public at large | Counts V–VI dismissed for lack of Article III standing |
Key Cases Cited
- Lujan v. Defenders of Wildlife, 504 U.S. 555 (U.S. 1992) (establishes standing elements: injury, causation, redressability)
- Summers v. Island Earth Institute, 555 U.S. 488 (U.S. 2009) (standing requires direct injury by association plaintiffs’ members)
- Hall v. Sebelius, 667 F.3d 1293 (D.C. Cir. 2012) (POMS provisions upheld as consistent with Social Security Act; standing analysis discussed)
- NFIB v. Sebelius, 132 S. Ct. 2566 (S. Ct. 2012) (upheld individual mandate as a tax under Congress’s taxing power)
- United Food & Commercial Workers Union Local 751 v. Brown Group, Inc., 517 U.S. 544 (U.S. 1996) (associational standing principle; member injury suffices for organizational standing)
- Abbott Labs. v. Gardner, 387 U.S. 136 (U.S. 1967) (ripeness/administrative law doctrine applied to pre-enforcement challenges)