Brian HALL, et al., Appellants v. Kathleen SEBELIUS, Secretary of the United States Department of Health and Human Services, and Michael J. Astrue, Commissioner of the Social Security Administration, Appellees.
No. 11-5076.
United States Court of Appeals, District of Columbia Circuit.
Argued Oct. 13, 2011. Decided Feb. 7, 2012.
667 F.3d 1293
III
For the foregoing reasons, the petitions for review are denied.
Kent M. Brown argued the cause for appellants. With him on the briefs was Frank M. Northam.
Samantha L. Chaifetz, Attorney, U.S. Department of Justice, argued the cause for appellees. With her on the brief were Tony West, Assistant Attorney General, Ronald C. Machen Jr., U.S. Attorney, Beth S. Brinkmann, Deputy Assistant Attorney General, and Mark B. Stern, Attorney. R. Craig Lawrence, Assistant U.S. Attorney, entered an appearance.
Before: GINSBURG,1 HENDERSON, and KAVANAUGH, Circuit Judges.
Opinion for the Court filed by Circuit Judge KAVANAUGH, with whom Circuit Judge GINSBURG joins.
Dissenting opinion filed by Circuit Judge HENDERSON.
KAVANAUGH, Circuit Judge:
Plaintiffs’ lawsuit faces an insurmountable problem: Citizens who receive Social Security benefits and are 65 or older are automatically entitled under federal law to Medicare Part A benefits. To be sure, no one has to take the Medicare Part A benefits. But the benefits are available if you want them. There is no statutory avenue for those who are 65 or older and receiving Social Security benefits to disclaim their legal entitlement to Medicare Part A benefits. For that reason, the District Court granted summary judgment for the Government. We understand plaintiffs’ frustration with their insurance situation and appreciate their desire for better private insurance coverage. But based on the law, we affirm the judgment of the District Court.
I
Most citizens who are 62 or older and file for Social Security benefits are legally entitled to receive Social Security benefits. See
Plaintiffs Armey, Hall, and Kraus all receive Social Security benefits and are 65 or older. Therefore, they are automatically entitled to Medicare Part A benefits. But they want to disclaim their legal entitlement to Medicare Part A benefits.2 In other words, they want not only to reject the Medicare Part A benefits (which they are already free to do) but also to obtain a legal declaration that the Government cannot pay Medicare Part A benefits on their behalf. According to plaintiffs, if they could show their private insurers that they are not legally entitled to Medicare Part A benefits, they would receive additional benefits from their private insurers. Plaintiffs argue that the statute allows them to disclaim their legal entitlement to Medicare Part A benefits and that the agency has violated the statute by preventing them from doing so.3
II
We first consider plaintiffs’ standing. Plaintiffs claim that their private insurers have curtailed coverage as a result of plaintiffs’ entitlement to Medicare Part A benefits. Plaintiff Armey declared that his legal entitlement to Medicare Part A benefits led his Blue Cross plan to reduce coverage without a matching reduction in premium. Plaintiff Hall declared that his Mail Handlers plan stopped acting as his primary payer because of his legal entitlement to Medicare Part A benefits. They claim they would receive enhanced coverage from their private insurers if they were not entitled to Medicare Part A benefits. For purposes of the standing inquiry, we must accept those declarations as true.
We conclude that Armey and Hall have suffered injuries in fact from their reduced private insurance. They have shown causation because their private insurance has been curtailed as a direct result of their legal entitlement to Medicare Part A benefits. And as to redressability, plaintiffs claim that they could obtain additional coverage from their private insurance plans if allowed to disclaim their legal entitlement to Medicare Part A benefits.
Because Armey and Hall have standing, we need not address standing for the other plaintiffs. We therefore proceed to the merits.
III
Because plaintiffs are 65 or older and are entitled to Social Security benefits, they are “entitled to hospital insurance benefits” through Medicare Part A.
To be clear, plaintiffs already “may refuse to request Medicare payment” for services they receive and instead “agree to pay for the services out of their own funds or from other insurance.” MEDICARE CLAIMS PROCESSING MANUAL, Ch. 1, § 50.1.5 (2011). So they can decline Medicare Part A benefits.
But plaintiffs want something more than just the ability to decline Medicare payments.
What plaintiffs really seem to want is for the Government and, more importantly, their private insurers to treat plaintiffs’ decision not to accept Medicare Part A benefits as meaning plaintiffs are also not legally entitled to Medicare Part A benefits. But the problem is that, under the law, plaintiffs remain legally entitled to the benefits regardless of whether they accept them.
Consider an analogy. A poor citizen might be entitled under federal law to food stamps. The citizen does not have to take the food stamps. But even so, she nonetheless remains legally entitled to them. So it is here.
Plaintiffs offer four arguments for why they must be allowed to disclaim their legal entitlement to Medicare Part A benefits. None is persuasive.
First, plaintiffs say that the plain meaning of the statutory term “entitled” requires that the beneficiary be given a choice to accept or reject Medicare Part A. But plaintiffs’ entitlement is to “hospital insurance benefits” under Medicare Part A.
Second, plaintiffs claim that, by statute, Medicare Part A is a voluntary program. That‘s true in the sense that plaintiffs can always obtain private insurance and decline Medicare Part A benefits. But the fact that the program is voluntary does not mean there must be a statutory avenue for plaintiffs to disclaim their legal entitlement to Medicare Part A benefits.
Third, plaintiffs acknowledge that they can escape their entitlement to Medicare Part A benefits by disenrolling from Social Security and forgoing Social Security benefits. From that, plaintiffs contend that entitlement to Medicare Part A benefits has thereby been made a prerequisite to receiving Social Security benefits, in contravention of the statute governing entitlement to Social Security benefits. But plaintiffs have it backwards. Signing up for Social Security is a prerequisite to Medicare Part A benefits, not the other way around.
Fourth, plaintiffs note that entitlement to Social Security benefits is optional and argue that entitlement to Medicare Part A should likewise be optional. But Social Security participation is optional because filing an application for benefits is a statutory prerequisite to entitlement. See
In sum, plaintiffs’ position is inconsistent with the statutory text. Because plaintiffs are entitled to Social Security benefits and are 65 or older, they are automatically entitled to Medicare Part A benefits. The statute offers no path to disclaim their legal entitlement to Medicare Part A benefits. Therefore, the agency was not required to offer plaintiffs a mechanism for
*
We affirm the judgment of the District Court.
So ordered.
KAREN LECRAFT HENDERSON, Circuit Judge, dissenting:
In Silver Blaze, a prized race horse disappears from its stable on the eve of a high-stakes race. By the time Inspector Gregory arrives from Scotland Yard, Sherlock Holmes is on the case.
Gregory: “Is there any point to which you would wish to draw my attention?”
Holmes: “To the curious incident of the dog in the night-time.”
Gregory: “The dog did nothing in the night-time.”
Holmes: “That was the curious incident.”
SIR ARTHUR CONAN DOYLE, MEMOIRS OF SHERLOCK HOLMES 22 (A.L. Burt Co. 1922) (1894). What led Holmes to conclude that the dog knew the thief was its silence. The dog did not bark. Ditto here. The majority‘s silence on the sole question in this case—is the Social Security Administration (SSA) authorized to penalize an individual who seeks to decline Medicare, Part A coverage by requiring him to forfeit his Social Security benefits and repay any benefits previously received—provides the answer: no. Because I believe that SSA‘s Program Operations Manual System (POMS) gives the SSA power that the Congress in no way provides, I respectfully dissent.1
I.
The Medicare Act,
Every individual who:
(1) has attained age 65, and
(2)(A) is entitled to monthly insurance benefits under [
42 U.S.C. § 402(a) ],...
shall be entitled to hospital insurance benefits under part A ... for each month for which he meets the condition specified in paragraph (2)....
Every individual who
(1) is a fully insured individual (as defined in [
42 U.S.C. § 414(a) ]),(2) has attained age 62, and
(3) has filed application for old-age insurance benefits ...
shall be entitled to ... old-age insurance benefit[s]....
The POMS is a massive internal set of provisions, produced without notice and comment rulemaking and used by SSA employees to process claims for SSRB. See Wash. Dep‘t of Soc. & Health Servs. v. Keffeler, 537 U.S. 371, 385, 123 S.Ct. 1017, 154 L.Ed.2d 972 (2003) (POMS provides “the publicly available operating instructions for processing Social Security claims“); Power v. Barnhart, 292 F.3d 781, 786 (D.C.Cir.2002) (POMS is an “interpretive document” “lack[ing] ... administrative formality“). The provisions of the POMS relating to HI alone include more than 100 printed pages. See SSA‘s Program Operations Manual System, https://secure.ssa.gov/apps10/poms.nsf/chapterlist!openview&restricttocategory=06 (last visited Jan. 23, 2012).3 The plaintiffs4 limit their statutory, procedural and constitutional challenges to three provisions of the POMS, arguing that they impermissibly tether Medicare, Part A entitlement to SSRB by penalizing them if they decline Medicare, Part A coverage.
The first of the three challenged provisions, POMS HI 00801.002, reveals the ad hoc manner in which the entire POMS was assembled. The “Introduction” to the provision provides in full: “Some individuals entitled to monthly benefits have asked to waive their HI entitlement because of religious or philosophical reasons or because they prefer other health insurance.” POMS HI 00801.002. Then, without so much as a word of explanation as to the statutory basis or rationale behind it, the provision announces SSA‘s answer, dubbing it “Policy.”
Individuals entitled to monthly benefits which confer eligibility for HI may not waive HI entitlement. The only way to avoid HI entitlement is through withdrawal of the monthly benefit application. Withdrawal requires repayment of all [SSRB] and HI benefit payments made.5
POMS HI 00801.002 (emphasis in original). The other two provisions are equally opaque as to their rationale and silent on their authority. POMS HI 00801.034 provides:
To withdraw from the HI program, an individual must submit a written request for withdrawal and must refund any HI benefits paid on his/her behalf as explained in GN 00206.095 B.1.c.
An individual who filed an application for both monthly benefits and HI may:
- withdraw the claim for monthly benefits without jeopardizing HI entitlement; or
- withdraw the claim for both monthly benefits and HI.
The individual may not elect to withdraw only the HI claim.
II.
“Not every agency interpretation of a statute is appropriately analyzed under Chevron [U.S.A., Inc. v. Natural Resources Defense Council, Inc., 467 U.S. 837, 104 S.Ct. 2778, 81 L.Ed.2d 694 (1984)].” Ala. Educ. Ass‘n v. Chao, 455 F.3d 386, 392 (D.C.Cir.2006). Indeed, Chevron deference is appropriate only if the Congress has delegated authority to an agency to make rules having the “force of law” and the agency rule at issue was “promulgated in the exercise of that authority.” United States v. Mead Corp., 533 U.S. 218, 226-27, 121 S.Ct. 2164, 150 L.Ed.2d 292 (2001). Although SSA Commissioner Astrue is authorized to issue rules with the “force of law,” see
Here, the scope of the relevant provisions of the Medicare and Social Security Acts is as plain as the definition of “entitled.” Under
Both in legal and general usage, the normal meaning of entitlement is a right or benefit for which a person qualifies.... It means only that the person satisfies the prerequisites attached to the right.
Ingalls Shipbuilding v. Dir., 519 U.S. 248, 256, 117 S.Ct. 796, 136 L.Ed.2d 736 (1997) (internal quotation marks and citation omitted). This definition has been applied by our Circuit and others in interpreting the terms “entitlement” and “entitled” as they are used in other parts of the Social Security and Medicare Acts. See Krishnan v. Barnhart, 328 F.3d 685, 688 (D.C.Cir.2003) (to be “entitled” means that an individual “qualifies” or has met the requisite requirements to obtain the benefits); Jewish Hospital, Inc. v. Sec‘y of HHS, 19 F.3d 270, 275 (6th Cir.1994) (as used in the Medicare Act, “[t]o be entitled ... means [to] possess[] the right or title to that benefit” (emphasis removed)); Fagner v. Heckler, 779 F.2d 541, 543 (9th Cir.1985) (as used in Social Security Act, “entitled means to give right or legal title to, qualify (one) for something; furnish with proper grounds for seeking or claiming something” (internal quotation marks and citation omitted)).
Although the district court noted that the “plain-English reading of the word ‘entitled’ has its attraction[ ],” the court nonetheless held that “in context [of] Medicare ‘entitled’ does not actually mean ‘capable of being rejected.‘” Hall v. Sebelius, 770 F.Supp.2d 61, 67 (D.D.C.2011). If the Congress had wanted to make enrollment in Part A optional, the court stated, it would have said so expressly. Id. at 67-68. In
My colleagues reach a similar conclusion. Citing a single provision of Secretary Sebelius‘s Medicare Claims Processing Manual, they conclude:
Congress could have made entitlement to Medicare Part A benefits depend on an application. But Congress instead opted to make entitlement to Medicare Part A benefits automatic for those who receive Social Security Benefits and are 65 or older.
Plaintiffs Hall and Armey do not dispute that entitlement to Medicare, Part A occurs by operation of law. See Reply Br. at 2 (“Plaintiffs-Appellants never suggested that they sought to renounce their entitlement to Medicare, Part A, and they did not contend that the Defendant-Appellees must allow them to ... somehow declare that Plaintiffs-Appellants are not entitled to Medicare, Part A.“). Instead, they argue something much more fundamental, i.e., that there is no statutory authority for the POMS‘s edict that an individual who declines Medicare, Part A coverage is required to forgo/refund SSRB. I agree. The relevant language of both statutes,
In American Bar Association v. FTC, we made plain that an agency cannot exercise regulatory power without congressional grant. 430 F.3d 457, 468 (D.C.Cir.2005).
Because there is no statutory basis for the challenged provisions of the POMS, they are ultra vires. “The legislative power of the United States is vested in the Congress, and the exercise of quasi-legislative authority by governmental departments and agencies must be rooted in a grant of such power by the Congress and subject to limitations which that body imposes.” See Chrysler Corp. v. Brown, 441 U.S. 281, 302, 99 S.Ct. 1705, 60 L.Ed.2d 208 (1979). The authority to administer the law is not the power to make the law. Orion Reserves Ltd. P‘ship v. Salazar, 553 F.3d 697, 703 (D.C.Cir.2009). Accordingly, “a regulation contrary to a statute is void.” Id. Commissioner Astrue is clothed with exceptional authority but even he cannot make law.12
For the foregoing reasons, I respectfully dissent.
