Supreme Court rules Lewiston health insurer is owed $59M in fed back payments
File Photo / Tim Greenway
Kevin Lewis, president and CEO of Community Health Options, said the Supreme Court decision was a "vindication of the rule of law."
The U.S. Supreme Court on Monday ruled that Community Health Options, a nonprofit health insurer based in Lewiston, is entitled to $59 million in back payments the federal government never made for the company’s participation in the Affordable Care Act.
In an 8-1 decision, the court held that the government was obligated to reimburse health insurance companies for losses under the Risk Corridors Program established by the act.
The program created financial risk-sharing between the federal Department of Health and Human Services and insurers who joined the ACA’s health insurance “marketplace” during its first three years. Carriers who profited through the ACA exchanges were to pay the government; carriers who lost money were to be compensated by it.
Community Health Options participated in the marketplace and paid into the Risk Corridor Program in 2014, the first year of its operation. But when the company incurred losses during 2015 and 2016, it didn’t receive payouts from the program — “supposedly due to lack of appropriation,” CHO said in a news release.
The insurer filed a lawsuit in 2018 over the issue.
In the Supreme Court case, a Washington, D.C., law firm representing CHO argued that the government was committed to the payment; that Congress did not repeal this obligation; that appropriation of funds was not required; and that CHO had the right to sue for damages.
“The Supreme Court’s decision is a vindication of the rule of law and should restore faith that a contract with the government is not by itself a risky undertaking,” Community Health Options President and CEO Kevin Lewis said in a statement.
“This win is particularly meaningful for us as a nonprofit health plan because it’s a win for our membership of individuals, families and businesses.”
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