Maine Community Health Options v. United States
140 S. Ct. 1308
| SCOTUS | 2020Background
- The Affordable Care Act created exchanges and a three‑year Risk Corridors program (§1342) that mandated payments: profitable plans "shall pay" the Government and unprofitable plans the Government "shall pay" according to a statutory formula.
- Congress did not appropriate specific, capped funds for §1342 payments; HHS and CMS interpreted the statute as creating a payment obligation regardless of collections.
- From 2014–2016 the program ran large deficits (total ≈ $12 billion); profitable-plan collections were far less than payments owed to unprofitable plans.
- Congress enacted annual appropriations riders forbidding use of certain CMS Program Management funds for Risk Corridors payments.
- Several insurers sued in the Court of Federal Claims under the Tucker Act for unpaid §1342 amounts; the Federal Circuit held the riders impliedly repealed the obligation. The Supreme Court granted certiorari.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether §1342 created a money‑mandating government obligation to pay unprofitable insurers | §1342's mandatory "shall pay" language and backward‑looking formula create a statutory obligation owed upon insurers' participation | Any payment duty is contingent on appropriations and the Anti‑Deficiency/Appropriations Clause limits enforceable payments | Held: §1342 is money‑mandating; its plain "shall" language and structure created an obligation not conditioned on appropriations |
| Whether subsequent appropriations riders impliedly repealed or suspended that obligation | Riders merely limited use of particular appropriation funds for specific fiscal years and did not expressly repeal §1342 | Riders, by cutting off CMS Program Management funds, evidences Congress' intent to cap Government payments to amounts collected | Held: Riders did not clearly and manifestly repeal §1342; implied repeals are disfavored, and these riders are at most a temporary funding shortfall |
| Whether insurers may sue the United States in the Court of Federal Claims under the Tucker Act for §1342 unpaid amounts | The statute is "money‑mandating" and therefore fairly interpreted to permit damages claims under the Tucker Act | No Tucker Act claim: either §1342 lacks a damages remedy, or another remedial scheme/APA remedies displace Tucker Act jurisdiction | Held: §1342 is money‑mandating and no alternative remedial scheme applies; insurers may sue in the Court of Federal Claims for damages |
Key Cases Cited
- United States v. Langston, 118 U.S. 389 (1886) (statute‑created salary obligation survives later insufficient appropriations)
- United States v. Vulte, 233 U.S. 509 (1914) (mere failure to appropriate does not impliedly repeal payment obligation)
- United States v. Will, 449 U.S. 200 (1980) (appropriations language can effect repeal when it expressly suspends obligation)
- United States v. Dickerson, 310 U.S. 554 (1940) (appropriations can suspend obligations when clearly expressed)
- United States v. Testan, 424 U.S. 392 (1976) (Tucker Act requires an independent money‑mandating source to ground damages)
- United States v. Mitchell, 463 U.S. 206 (1983) (distinguishing when statutes create money‑mandating rights and when other remedies govern)
- United States v. White Mountain Apache Tribe, 537 U.S. 465 (2003) (statute gives rise to Tucker Act claim if it can fairly be interpreted as mandating compensation)
- Bowen v. Massachusetts, 487 U.S. 879 (1988) (distinguishing prospective equitable relief under the APA from Tucker Act money claims)
- United States v. Bormes, 568 U.S. 6 (2012) (limits on when Tucker Act is displaced by a statute's own remedy)
- Salazar v. Ramah Navajo Chapter, 567 U.S. 182 (2012) (statutory and contractual obligations of the Government remain enforceable despite appropriations shortfalls)