Moda Health Plan, Inc. v. United States

United States Court of Appeals for the Federal Circuit ______________________ MODA HEALTH PLAN, INC., Plaintiff-Appellee v. UNITED STATES, Defendant-Appellant ______________________ 2017-1994 ______________________ Appeal from the United States Court of Federal Claims in No. 1:16-cv-00649-TCW, Judge Thomas C. Wheeler. ______________________ Decided: June 14, 2018 ______________________ STEVEN ROSENBAUM, Covington & Burling LLP, Washington, DC, argued for plaintiff-appellee. Also represented by SHRUTI CHAGANTI BARKER, CAROLINE BROWN, PHILIP PEISCH. ALISA BETH KLEIN, Appellate Staff, Civil Division, United States Department of Justice, Washington, DC, argued for defendant-appellant. Also represented by CHAD A. READLER, MARK B. STERN. 2 MODA HEALTH PLAN, INC. v. UNITED STATES THOMAS G. HUNGAR, Office of General Counsel, Unit- ed States House of Representatives, Washington, DC, for amicus curiae United States House of Representatives. Also represented by KIMBERLY HAMM, TODD B. TATELMAN. WILLIAM LEWIS ROBERTS, Faegre Baker Daniels LLP, Minneapolis, MN, for amicus curiae Association for Com- munity Affiliated Plans. Also represented by JONATHAN WILLIAM DETTMANN, KELLY J. FERMOYLE, NICHOLAS JAMES NELSON. STEVEN ALLEN NEELEY, JR., Husch Blackwell LLP, Washington, DC, for amicus curiae National Association of Insurance Commissioners. STEPHEN A. SWEDLOW, Quinn Emanuel Urquhart & Sullivan, LLP, Chicago, IL, for amicus curiae Health Republic Insurance Company. URSULA TAYLOR, Butler Rubin Saltarelli & Boyd LLP, Chicago, IL, for amicus curiae Blue Cross Blue Shield Association. Also represented by SANDRA J. DURKIN. BENJAMIN N. GUTMAN, Oregon Department of Justice, Salem, OR, for amici curiae State of Oregon, State of Alaska, State of Connecticut, State of Hawaii, State of Illinois, State of Iowa, State of Maryland, State of Massa- chusetts, State of Minnesota, State of New Mexico, State of North Carolina, State of Pennsylvania, State of Rhode Island, State of Vermont, State of Virginia, State of Washington, State of Wyoming, District of Columbia. ______________________ Before PROST, Chief Judge, NEWMAN and MOORE, Circuit Judges. Opinion for the court filed by Chief Judge PROST. MODA HEALTH PLAN, INC. v. UNITED STATES 3 Dissenting opinion filed by Circuit Judge NEWMAN. PROST, Chief Judge. A health insurer contends that the government failed to satisfy the full amount of its payment obligation under a program designed to alleviate the risk of offering cover- age to an expanded pool of individuals. The Court of Federal Claims entered judgment for the insurer on both statutory and contract grounds. The government appeals. We reverse. BACKGROUND This case concerns a three-year “risk corridors” pro- gram described in the Patient Protection and Affordable Care Act, Pub. L. No. 111-148, 124 Stat. 119 (2010) (codi- fied at 42 U.S.C. §§ 18001 et seq.) (“ACA”), and imple- mented by regulations promulgated by the U.S. Department of Health and Human Services (“HHS”). The case also concerns the bills that appropriated funds to HHS and the Centers for Medicare & Medicaid Services (“CMS”) within HHS for the fiscal years during which the program in question operated. We begin with the ACA. I. The ACA Among other reforms, the ACA established “health benefit exchanges”—virtual marketplaces in each state wherein individuals and small groups could purchase health coverage. 42 U.S.C. ...

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