969 F.3d 1370
Fed. Cir.2020Background
- The ACA required states to create health-insurance exchanges and directed insurers to reduce cost‑sharing for certain eligible enrollees; 42 U.S.C. § 18071(c)(3) states the HHS Secretary “shall make periodic and timely payments” reimbursing insurers for those reductions.
- Congress did not include a permanent appropriation expressly for cost‑sharing reduction (CSR) reimbursements, though it did for premium tax credits.
- From 2014 the government made CSR payments; in October 2017 the Administration stopped CSR reimbursements citing appropriation concerns.
- Sanford Health Plan and Montana Health CO‑OP sued in the Court of Federal Claims for unpaid CSR reimbursements for the last quarter of 2017; the Court of Federal Claims granted summary judgment for both plaintiffs and entered judgments.
- The government appealed; after briefing, the Supreme Court decided Maine Community Health Options v. United States, which guided the Federal Circuit’s analysis. The Federal Circuit affirmed, holding § 18071(c)(3) is money‑mandating and Tucker Act damages are available.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether 42 U.S.C. § 18071(c)(3) is a money‑mandating statute that supports Tucker Act damages | §18071(c)(3)’s unqualified “shall make … payments” creates a federal obligation and thus permits Tucker Act suits | The statute is not money‑mandating (or is limited by appropriations or other provisions) so Tucker Act relief is unavailable | Court: §18071(c)(3) is money‑mandating; Tucker Act damages are available (applying Maine Community) |
| Whether the existence of the premium tax‑credit mechanism displaces Tucker Act damages for CSR nonpayment | Insurers keep their Tucker Act remedy even if premium tax credits can sometimes offset CSR losses | The premium tax‑credit mechanism (and interaction of subsidies) means Congress intended no Tucker Act remedy—any loss will be addressed through premium adjustments and tax credits | Court: Premium tax credits do not categorically displace Tucker Act relief; offsets/double‑recovery issues are handled in damages accounting, not by denying Tucker Act jurisdiction |
| Whether ACA or other statutory/administrative remedies (including the APA) provide the exclusive remedy, barring Tucker Act suits | Plaintiffs seek money for past, calculable sums; ACA contains no exclusive judicial remedy for §18071(c)(3) violations | Government argued APA or ACA remedial scheme (or appropriations limits) precludes Tucker Act suits | Court: Neither APA nor an ACA‑based remedial scheme displaces Tucker Act here; plaintiffs seek retrospective money damages, not prospective APA relief |
| Whether lack of a specific appropriation or appropriations law (or implied repeal/suspension) prevents liability | The absence of an explicit appropriation does not prevent a statute from being money‑mandating under Tucker Act (post‑Maine Community) | Government argued appropriations constraints (and prior briefing) meant no enforceable money obligation | Court: Following Maine Community, lack of a specific appropriation does not defeat a money‑mandating statutory obligation; government did not press an implied repeal/suspension defense here |
Key Cases Cited
- Maine Community Health Options v. United States, 140 S. Ct. 1308 (U.S. 2020) (Risk Corridors "shall pay" language is money‑mandating; Tucker Act damages available)
- United States v. Navajo Nation, 556 U.S. 287 (U.S. 2009) (statute must be fairly interpreted as mandating compensation to waive sovereign immunity)
- United States v. White Mountain Apache Tribe, 537 U.S. 465 (U.S. 2003) (money‑mandating statute principles)
- Bowen v. Massachusetts, 487 U.S. 879 (U.S. 1988) (APA may provide an alternative remedial route that bars Tucker Act relief for certain claims)
- Bormes v. United States, 568 U.S. 6 (U.S. 2012) (statutes that provide their own judicial remedies can displace Tucker Act)
- Horne v. Department of Agriculture, 569 U.S. 513 (U.S. 2013) (example of statutes with specific remedial schemes)
- Moda Health Plan, Inc. v. United States, 892 F.3d 1311 (Fed. Cir. 2018) (Federal Circuit held Risk Corridors provision money‑mandating but found implied repeal/suspension; later addressed by Maine Community)
- Sanford Health Plan v. United States, 139 Fed. Cl. 701 (Ct. Fed. Cl. 2018) (trial court judgment for insurer finding §18071 money‑mandating)
- Montana Health CO‑OP v. United States, 139 Fed. Cl. 213 (Ct. Fed. Cl. 2018) (trial court judgment for insurer finding §18071 money‑mandating)