St. Louis Effort For AIDS v. John Huff
2015 U.S. App. LEXIS 5812
| 8th Cir. | 2015Background
- Plaintiffs allege Missouri's Health Insurance Marketplace Innovation Act (HIMIA) is preempted by the ACA, violates First Amendment, and is void for vagueness; they seek a preliminary injunction.
- Missouri enacted HIMIA to regulate state navigators and related personnel operating with respect to exchanges; provisions include licensing, regulation, and a remedial provision.
- The district court enjoined HIMIA as to CACs and two challenged substantive provisions, finding potential ACA preemption and severability concerns.
- HHS operates a Federally-facilitated Exchange (FFE) in Missouri; CACs provide information about exchange options under federal standards.
- The 2014 HHS regulations governing CACs clarified preemption scope and informed the court’s consideration of forward-looking relief, affecting the disputed provisions.
- The court ultimately held three HIMIA provisions concerning CACs likely preempted and affirmed an injunction against them, while vacating rest of the injunction.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether the ACA preempts HIMIA provisions | Plaintiffs contend the ACA preempts the challenged provisions. | Huff argues state regulation is preempted where conflicting with federal navigator duties. | Three provisions likely preempted; preemption limited to CACs. |
| Whether the 2014 regulations affect preemption | Regulations clarify preemption scope to CACs and support preemption. | Regulations are interpretive or legislative; may be given weight but do not control preemption. | Regulations support independent preemption but do not compel outcome. |
| Whether § 376.2002.3(3) (no-advice) conflicts with federal duties of CACs | No-advice prohibition conflicts with CACs’ duty to provide information about plan options. | No conflict because prohibition targets advice, not information. | Likely preempted as to CACs; provision interferes with federal duties. |
| Whether § 376.2002.3(5) (no off-exchange info) is preempted | Off-exchange information is necessary to clarify plan distinctions. | Regulation may restrict information beyond exchange plans. | Likely preempted; interferes with CACs’ duties to inform about options. |
| Whether § 376.2008 (refer to an insurance producer) is preempted | Referral to producers conflicts with CACs’ obligation to provide impartial information. | Referral aligns with guiding consumers to appropriate resources. | Likely preempted; hinders CACs’ federal duties. |
| Whether § 376.2010.1 (remedial) is void for vagueness | The phrase 'or for other good cause' lacks fair notice and invites arbitrary enforcement. | Statutory text limits suspensions and fines to enumerated acts; not vague as applied. | Vagueness challenge not likely to succeed; not applicable to First Amendment context here. |
Key Cases Cited
- In re Aurora Dairy Corp. Organic Milk Mktg. & Sales Practices Litig., 621 F.3d 781 (8th Cir. 2010) (preemption analysis; reliance on express statutory language)
- Medtronic, Inc. v. Lohr, 518 U.S. 470 (1996) (preemption requires clear congressional intent)
- Heart of American Grain Insp. Serv., Inc. v. Mo. Dep’t of Agric., 123 F.3d 1098 (8th Cir. 1997) (tension between state law and federal objectives in preemption)
- Chapman v. Lab One, 390 F.3d 620 (8th Cir. 2004) (plain-language approach to preemption inquiry)
- Wyeth v. Levine, 555 U.S. 555 (2009) (agency preemption weight depends on thoroughness and consistency)
- Landgraf v. USI Film Prods., 511 U.S. 244 (1994) (intervening regulations; forward-looking injunctions; no vested rights)