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Bad people in a position to do bad things will do bad things because they are bad people. End of story.

Their freedom requires your slavery.

In after Baud. Damn.

“Just close your eyes and kiss the girl and go where the tilt-a-whirl takes you.” ~OzarkHillbilly

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The next time the wall street journal editorial board speaks the truth will be the first.

Following reporting rules is only for the little people, apparently.

You are here: Home / Anderson On Health Insurance / Insurers win in the Supreme Court for the ACA

Insurers win in the Supreme Court for the ACA

by | 40 Comments

This post is in: 

This morning, the Supreme Court released an ACA decision (no — not that decission).  Insurers are in line to receive risk corridor payments in full plus any applicable damages from the federal government in an 8-1 decision:

 


 

Insurers entered the ACA market with the understanding that there would be a risk corridor that would limit their losses and gains from 2014-2016. The ACA individual market is a market that has fundamental structural differences than other insurance markets and it was fundamentally unknown and unknowable how it would play out in the first couple of years until experience had been digested and learning occurred. The federal government promised that it would eat some of the risk of fundamnental actuarial oopsies with a risk corridor provision. The policy objective was to get more insurers into the market. When the insurers entered the market, they priced with a backstop in mind. However, the CROMNIBUS limited the funds that could be used to pay for this backstop to only what was collected by insurers that fundamentally overpriced the market. Many insurers went broke and withdrew from the market as they had counted on the backstop. And then they sued.

Now they won.

Now what does this mean?

It means very little in the short term. It won’t change premiums this year. It won’t change premiums next year. It may have funky Medical Loss Ratio (MLR) implications depending on how the revenue lands on insurers’s books.

In the long term, it reinforces that the “full faith and credit” of the US government actually matters and it can’t be readily weaseled out of with an appropriations rider.

Reader Interactions

40Comments

  2. 2.

    David Fud

    I have an off-topic health care question, if that is ok.  I am hearing about a $100MM loss in one month in a Maine health care system.  I would like to know if insurers 1) feel any particular interest in helping their symbiotic partners in resource extraction weather the storm of COVID-19; and, 2) have come out relatively unscathed, like the auto insurers, or if they are being severely damaged by COVID-19 as well.

    I am unaware of any discussion or provision of the various stimulus packages related to improving the financial situation of hospitals or insurance companies.  I am sure I have missed the articles, but is it possible that there a summary you could point me toward so I can learn a bit about that?  I know that Google is a thing and all, but I was looking for the improved fare you usually provide, Mr. Anderson, and thank you ahead of time for any work and consideration you have to put into these research/opinion requests.

  3. 3.

    clay

    So which Justice thinks it’s okay for the United States to knowingly and intentionally break lawful contracts?  I’m guessing Thomas, but it could be Gorsuch or Alito.

  8. 8.

    Sister Rail Gun of Warm Humanitarianism

    @clay: Alito. His dissent starts:

    Twice this Term, we have made the point that we have basically gotten out of the business of recognizing private rights of action not expressly created by Congress.

    Congress hasn’t done every jot and tittle, so he wanted to defer action for more hearings.

  9. 9.

    TS (the original)

    SOTOMAYOR, J., delivered the opinion of the Court, in which ROBERTS,
    C. J., and GINSBURG, BREYER, KAGAN, and KAVANAUGH, JJ., joined, and in
    which THOMAS and GORSUCH, JJ., joined as to all but Part III–C. ALITO,
    J., filed a dissenting opinion.

    From the link in the tweet.

    Edit: As others said before me.

  10. 10.

    Barbara

    There are some people in my professional orbit who are insanely happy at this development.  You have to go back to the Reagan administration to find a government position taken in such blistering bad faith. The Reagan administration announced what it called the “nonadherence” doctrine, under which it refused to recognize court decisions in the area of disability law and determinations as precedent except in the narrowest terms possible. it took the Supreme Court to tell HHS that it was required to follow court decisions as precedent within districts and circuit regions.

  11. 11.

    different-church-lady

    OT: got my “Explanation of Benefits” from my insurer for my recent hospital stay. (Said statement says quite clearly, “NOT A BILL”)

    According to said document, not as single dime is covered by my insurance.

    Question: how seriously do I take this thing? Should I start making phonecalls now, or wait for more paperwork to develop?

  12. 12.

    rp

    I’ve argued to friends in the past that Alito is by far the worst Justice, so I’m thrilled that he’s proved me right! Huzzah!

  14. 14.

    different-church-lady

    @trollhattan: god willing, two weeks from now the zeitgeist has changed to “Why hasn’t Trump held a virus press briefing in two weeks? He’s abandoned his leadership role.”

  15. 15.

    gene108

    @different-church-lady: 

    I’d call the insurer to find out why they reached that decision. I’ve had a few bills that were amended, because the hospital or doctor didn’t use the right billing code for the insurance to cover the procedure.

  16. 16.

    Barbara

    @different-church-lady: What is you deductible?  I have a high deductible plan and there are some years when nothing is covered.  Usually, however, there is a reason code somewhere in the statement, and then a list of what those codes mean on the back or a second page.  Look for that to see if there is any further explanation.

  18. 18.

    Ben Cisco

    @trollhattan: He didn’t have any over the weekend either, if memory serves. Guess between the bleach memes, the Wile E. Coyote-like blowup of his so-called “sarcasm” excuse, and the blowback (so bad that even Wolf Blitzer got in a shot), a nerve was actually found.

  19. 19.

    Kelly

    Good to see “full faith and credit” affirmed. Should have been a slam dunk decision in time to save the Co-ops that went bankrupt after the risk corridor money was pulled without warning. The Co-ops were a good thing we’ll never get back.

  20. 20.

    Dadadadadadada

    @different-church-lady: I hope for the zeitgeist in two weeks to be “Oh, thank dog Trump hasn’t opened his fat mouth in over two weeks, and the experts are doing a much better job without him, and in only 8 months he’ll be gone for good.”

  21. 21.

    MomSense

    The Republicans have tried to sabotage the ACA ever since it was passed.  They tried to stop the passage by promoting a bunch of lies that our stupid media couldn’t be bothered to fact check.

    One of the reasons I am so leery about Medicare for All is because I do not think a Republican administration can be trusted to run it.

  22. 22.

    Ohio Mom

    Different Church Lady@11: Maybe call the hospital billing department or social worker? They deal with insurance companies all day and have much experience deciphering Insurance-speak.

    Plus they have a vested interest in wrangling as many dollars out of Insurance companies as possible.

    Finally, if you are indeed responsible for some/all of the bill (please FSM, no), you are going to have to negotiate with them, might as well get a head start on figuring out who is who in the billing department.

    That’s my first instinct. Which reminds me, I told Ohio Dad I would take over arguing with his endocrinologist’s billing office on the refund they owe him. Off to make calls, good luck, DCL!

  23. 23.

    Raoul

    We’re all so wrapped up in the deadly clown show of GOP malfeasance, but what this also means is that a Republican stunt meant to weaken ACA just backfired terribly, and depending on the damages calculation, will probably cost all of us extra as taxpayers.
    What a bunch of f–kwads. But we knew that already. Vote ’em out!

  25. 25.

    Raoul

    @trollhattan: Very glad that the orange menace has limped back to his favorite TV couch. But a little worried at not seeing Fauci (and other folks who should be held to account like Birx, Azar, etc, oh and the ‘chair’ of the taskforce, whatshismug, Mother’s husband?).

    It’s Axios, so ymmv, but this is lame “Deborah Birx and Anthony Fauci — ‘will continue but take a back seat to the forward-looking, what’s next message,’ a White House official said.”  Time to pivot to hopeful sunshine-blowing about the economy, apparently.

    If we don’t talk about the lack of medical progress, then all is well for the re-election campaign. Idiotic magical thinking, refreshed daily.

  27. 27.

    Redshift

    @different-church-lady: Based on my experience when my insurance ruled a round of cancer treatment was “not medically necessary,” I’d say call the hospital billing department. After I freaked out and after going back and forth with both the hospital and insurance finally made sure to register a dispute with my insurance before the deadline, I finally got a helpful person at the hospital who said “unless we send you a bill, don’t worry about it, we’ll deal with it.” A year later, insurance finally paid.

  28. 28.

    trnc

    In the long term, it reinforces that the “full faith and credit” of the US government actually matters and it can’t be readily weaseled out of with an appropriations rider.

    It also means that, once again, DT’s refusal to acknowledge any rules and policies duly created before he besmirched the Oval Office will cost taxpayers money for the payments of damages to the insurers he screwed. I feel dirty even suggesting that an insurance company can be a victim, but here we are.

  29. 29.

    Barbara

    @Redshift: That sounds like a coding issue.  I don’t normally deal with coding issues, but I am told by experts that many coding specialists use generic or general codes that frequently get kicked out, and then they go back and use more specialized codes, which requires more evaluation of the actual record.

  30. 30.

    Elizabelle

    That is ridiculous.  No daily briefing — which Cuomo is certainly up to — because, Trump.

    Because that MOFO cannot just let Fauci and Birx and any other expert take the limelight and provide professional advice.  More to the point, he does not want to hear the mass of applause that would follow the White House doing that.

    Screw Trump and screw Alito too.

    Also, FWIW, at three years out, still don’t think of Trump as a professional.  He is a toddler who cannot be fired.

  31. 31.

    WaterGirl

    @Elizabelle: So Trump’s daily (worthless) briefing was cancelled?  Wouldn’t that be a good thing?

    Unless you are saying that Cuomo’s daily briefing is cancelled because of Trump?

    I am confused.

  32. 32.

    Uncle Cosmo

    Alito: Scalia-level scumbag with half the brains.

    Cuomo, Fauci, Nancy (D’Alesandro) Pelosi – Help me out here, folks, can anyone think of any other prominent Italian-Americans who aren’t disgraces to the human race? We seem to have a foccatonna of the latter…

  33. 33.

    trnc

    @WaterGirl: @Elizabelle: So Trump’s daily (worthless) briefing was cancelled?  Wouldn’t that be a good thing?

    I’m with WaterGirl on this. I don’t think there’s all that much to learn from a daily briefing at this point, even from non-insane people like Cuomo or Fauci. A weekly briefing is probably enough, assuming the oxygen isn’t chewed up with inane bullshit. If Fauci doesn’t get canned, he’ll be able to spend more time doing his actual job.

  38. 38.

    Elizabelle

    @trnc: @ WaterGirl:

    You are both right about Trump briefings having little value, because of the lies to game Americans into thinking he/the administration are doing much about COVID.

    Alas, per Jim on morning thread:

    Kayleigh McEnany @PressSec · 3m
    UPDATE: The White House has additional testing guidance and other announcements about safely opening up America again. President @realDonaldTrump will brief the nation during a press conference this evening.

    Whoever guessed Trump just could not stay away from the briefings got it.  It’s his oxygen.

  39. 39.

    artem1s

    The White House has additional testing guidance and other announcements about safely opening up America again. President @realDonaldTrump will brief the nation during a press conference this evening.

    so what kind of insane BS will fall out of his assmouth now?  App tracing is just like holocaust tattoing?  What’s the over/under on him declaring everyone’s been tested already?  and simultaneously declaring the latest miracle cure will negate the need for any further testing?  All.in.prime.time.  Jeebus what a dumbass

  40. 40.

    Ohio Mom

    Let Trump keep his daily briefings. I want Republicans to be reminded every day of what they have wrought.

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