United States v. Rhode Island Insurers' Insolvency FundUnited States v. Rhode Island Insurers' Insolvency Fund
The question in this appeal is whether section 1395y(b)(2)(A) of the Medicare Secondary-Payer Act,
I
BACKGROUND
Enacted by the Rhode Island Legislature in 1988, the RIIIFA requires all insurers licensed in Rhode Island to make
pro rata
monetary contributions to the Fund to meet certain types of insurance claims lodged against licensed Rhode Island insurers which have become insolvent,
In 1989-90, the federal Medicare program disbursed approximately $14,000 in medical benefits to three Medicare beneficiaries who had sustained injuries in automobile accidents. When their Rhode Island-licensed automobile insurance carrier, the American Universal Insurance Company (“AUIC”), was declared insolvent, the three Medicare beneficiaries filed claims against the Fund. The Fund allowed their claims but deducted the $14,000 previously disbursed to them under the federal Medicare program, citing RI-IIFA §§ 27 — 34—5(S)(ii)(C) and 27-34-12(b). The United States promptly challenged the deductions on the ground that RIIIFA §§ 27-34^5(8)(ii)(C) and 27-34-12(b), which purport to shift “primary” insurance coverage from the Fund to Medicare, are inconsistent with federal law, and thus preempted.
The pertinent MSP provision, found in Title XVIII of the Social Security Act,
When the Fund balked at voluntary reimbursement, the United States filed suit in federal district court for $28,000,
see id.
The United States alleged that the MSP provision does not permit the 1989-90 Medicare payments to be characterized as “primary” liability payments, since the injuries to the three Medicare beneficiaries were covered under a “primary plan” — their AUIC automobile insurance policies — and therefore the Fund, as the “deemed” insurer, must meet the maximum $300,000 primary AUIC insurance coverage cap under each beneficiary’s policy before Medicare could be held liable.
See
RJ.Gen.Laws § 27-34-8(a)(2). The United States moved for judgment on the pleadings, based on its preemption claim. The Fund filed a cross-motion for judgment on the pleadings, arguing, among other things, that the first clause of the MeCarran-Ferguson Act,
The district court granted judgment for the United States.
United States v. Rhode Island Insurers’ Insolvency Fund,
II
DISCUSSION
A. Standard of Review
We review judgments on the pleadings
de novo,
accepting all allegations and reasonable inferences favorable to the appellant.
See Santiago de Castro v. Morales Medina,
B. The McCarran-Ferguson Act
As this court has recognized, “[federal preemption under the Supremacy Clause,
see
First, the federal statute — here, the MSP provision in Title XVIII — must not “specifically relat[e] to the business of insurance.” Second, the state law — here, the RIIIFA— must have been enacted “for the purpose of regulating the business of insurance.” Third, the MSP provision must “invalidate, impair, or supersede” the RIIIFA provisions which purport to make the United States the “primary” insurer.
See United States Dep’t of the Treasury v. Fabe,
The district court ruled the McCarran-Ferguson Act .inapplicable because the first precondition recited above was not met; that is, it found that the MSP provision does “specifically relat[e] to the business of insurance.”
See Barnett Bank of Marion County v. Nelson,
— U.S.-,
1. “Speciñc Relation ”
The import of the “specific relation” element is readily discernible from its pre-en-actment history. Before 1944, the United States Supreme Court consistently had held that the
Dormant
Commerce Clause of the United States Constitution did not invalidate state insurance laws which imposed impermissible burdens on interstate commerce. However, when first confronted with an
affirmative
congressional enactment purporting to regulate the interstate business of insurance directly, the Court ruled that the business of insurance is part of “interstate commerce” and subject to regulation (hence, preemption) under Congress’s commerce-clause powers.
See United States v. South-Eastern Underwriters Ass’n,
Congress promptly repudiated the holding in
South-Eastern Underwriters,
by enacting the first clause of
The parties dispute whether the Medicare
program
itself specifically relates to insurance, since it was established long after the 1945 enactment of the McCarran-Ferguson Act, and, arguably at least, is not the typical insurer contemplated by
2. “Business of Insurance ”
The second element — that the federal statute actually pertain to activities that are part of the “business of insurance” — is satisfied as well. The MSP provision regulates the core relationship between a private insurer and its insured. “ ‘Statutes aimed at protecting or regulating th[e] relationship [between insurer and insured], directly or indirectly, are laws regulating the “business of insurance.’””
Fabe,
C. Conventional Preemption Analysis
Notwithstanding the inapplicability of the McCarran-Ferguson Act, the Fund argues that the priority mandated by the MSP provision does not trump the RIIIFA, even under conventional preemption analysis, because the priority provisions in the two statutes are compatible.
See Summit Inv. and Dev. Corp.,
Second, the Fund contends that it is not a “primary plan,” as defined by the MSP provision,
see
The RIIIFA itself provides that, upon a declaration of insolvency, the Fund is
“deemed
the insurer to the extent of the obligations [under the policy] on the covered claims,”
see
Ill
CONCLUSION
For the foregoing reasons, the district court judgment is affirmed, with costs to plaintiff-appellee.
Notes
. The Medicare regulations define a "plan" as “any arrangement, oral or written, by one or more entities, to provide health benefits or medical care or assume legal liability for injury or illness.”
. The McCarran-Ferguson Act provides, in pertinent part:
(a) The business of insurance, and every person engaged therein, shall be subject to the laws of the several States which relate to the regulation or taxation of such business.
(b) No Act of Congress shall be construed to invalidate, impair, or supersede any law enacted by any State for the purpose of regulating the business of insurance, or which imposes a fee or tax upon such business, unless such Act specifically relates to the business of insurance: Provided, That ... [the Sherman, Clayton, and FTC antitrust acts] shall be applicable to the business of insurance to the extent that such 'business is not regulated by State law.
. The House Report provides, in relevant part:
Under Title VIII, Medicare will have residual rather than primary liability for the payment of services required by a beneficiary’ as a result of an injury or illness sustained in an auto accident where payment for the provision of such services can also be made under an automobile insurance policy. Under this provision, it is expected that Medicare will ordinarily pay for the beneficiary’s care in (he usual manner and then seek reimbursement from the private insurance carrier after, and to the extent that, such carrier's liability under the private policy for the services has been determined. Under present law, Medicare is the primary payer (except where a workmen’s compensation program is determined to be responsible for payment for needed medical services) for hospital and medical services received by beneficiaries. This is true even in cases in which a beneficiary’s need for services is related to an injury or illness sustained in an auto accident and the services could have been paid for by a private insurance carrier under the terms of an automobile insurance policy. As a result, Medicare has served to relieve private insurers of obligations to pay the costs of medical care in cases where there would otherwise be liability under the private insurance contract. The orig-
inal concerns that prompted inclusion of this program policy in the law — the administrative difficulties involved in ascertaining private insurance liability and the attendant delays in payment — no longer justify retaining the policy, particularly if it is understood that immediate payment may be made by Medicare with recovery attempts undertaken only subsequently when liability is established. In order to avoid excessive administrative costs and efforts in pursuing minor recoveries, the committee expects the Secretary of HHS to establish in regulations rules regarding the minimum amounts estimated as recoverable and the procedures for seeking recovery from private Carti-ers. Such procedures are to be similar to those currently employed by Medicare in seeking recovery in workmen’s compensation cases.
H.R.Rep. No. 1167, 96th Cong., 2d Sess. 389, reprinted in 1980 U.S.C.C.A.N. 5526, 5752 (emphasis added). '
.
Fabe
defines the activities encompassed within the term "business of insurance,” albeit in the process of applying the second prong of
. The more specific challenges made by the Fund, based on the three-factor
Pireno
test, gain it nothing. First, the Fund contends that the MSP provision does not involve a practice which has the effect of transferring or spreading a policyholders’ risk,
see Pireno,
. Finally, the Fund raises a puzzling challenge to the implicit district court ruling that RIIIFA’s preempted provisions are severable from its non-preempted provisions. It argues that no part of RIIIFA can be struck down because the Rhode Island Legislature envisioned the Fund only as a “last resort” for insolvent insurers' policyholders, and that it would not have enacted RIIIFA at all had it known that its core "covered claim” definition was going to be so severely restricted with respect to Medicare benefits. Aside from its conjectural nature, this contention seems counterproductive from the Fund’s standpoint. If the preempted RIIIFA provision is not severable, of course, the proper relief is not, as the Fund apparently assumes, a holding that the entire RIIIFA stands as enacted, but the
invalidation
of the
entire
RIIIFA, which would result in appellant’s extinction.
See, e.g., Hooper v. Bernalillo County Assessor, 472
U.S. 612, 624,