{"ID":63146,"name":"Maine Community Health Options v. United States","href":"https:\/\/api.oyez.org\/cases\/2019\/18-1023","view_count":0,"docket_number":"18-1023","additional_docket_numbers":["18-1028","18-1038"],"manner_of_jurisdiction":"Writ of \u003Ci\u003Ecertiorari\u003C\/i\u003E","first_party":"Maine Community Health Options","second_party":"United States","timeline":[{"event":"Granted","dates":[1561352400],"href":"https:\/\/api.oyez.org\/case_timeline\/case_timeline\/54552"},{"event":"Argued","dates":[1575957600],"href":"https:\/\/api.oyez.org\/case_timeline\/case_timeline\/54625"},{"event":"Decided","dates":[1587963600],"href":"https:\/\/api.oyez.org\/case_timeline\/case_timeline\/54696"}],"lower_court":{"ID":17,"name":"United States Court of Appeals for the Federal Circuit","href":"https:\/\/api.oyez.org\/taxonomy\/term\/17"},"facts_of_the_case":"\u003Cp\u003ECongress, in order to persuade the nation\u2019s health insurance industry to provide insurance to previously uninsured or uninsurable persons, the legislation creating the Affordable Care Act provided that insurance losses over a designated percentage would be reimbursed, and comparable profits would be turned over to the government.\u003C\/p\u003E\n\u003Cp\u003EIn reliance on the government\u2019s commitment to reimburse them, the nation\u2019s insurance industry provided the designated health insurance. However, when some carriers experienced significant losses, the government refused to appropriate the funds to pay the statutory shortfall and prohibited existing funds from being used for this purpose. As a result, the insurers did not receive reimbursement.\u003C\/p\u003E\n\u003Cp\u003ESeveral of these insurance carriers filed suit against the government seeking reimbursement. The courts denied them the relief they sought, in part relying on the \u201ccardinal rule\u201d disfavoring implied repeals, which applies with \u201cespecial force\u201d to appropriations acts and requires that repeal not to be found unless the later enactment is \u201cirreconcilable\u201d with the former.\u003C\/p\u003E\n","question":"\u003Cp\u003EDo the insurance carriers in this case have a right to payment under the \u201cRisk Corridors\u201d program of the Affordable Care Act?\u003C\/p\u003E\n","conclusion":"\u003Cp\u003EThe insurance carriers in this case have a right to payment under the \u201cRisk Corridors\u201d program of the Affordable Care Act, Congress did not repeal the obligation of the federal government to pay the carriers, and the carriers can sue for payment under the Tucker Act in the Court of Federal Claims.\u003C\/p\u003E\n\u003Cp\u003EJustice Sonia Sotomayor delivered the opinion for an 8-1 majority. First, the Court considered whether the Risk Corridors program, Section 1342 of the Affordable Care Act, obligated the federal government to pay participating insurers the full amount calculated by the statute. Congress may create an obligation directly through statutory language, which it did through the Risk Corridors program, in plain language. Thus, the legal duty of the government became a legal liability when the insurance carriers participated in the health care exchanges.\u003C\/p\u003E\n\u003Cp\u003ESecond, the Court considered whether Congress impliedly repealed the obligation by passing appropriations riders. The Court first noted its \u201caversion to implied repeals,\u201d especially in the context of appropriations. For an implied repeal, the government must show more than merely the failure to appropriate sufficient funds, which it did not do here.\u003C\/p\u003E\n\u003Cp\u003EFinally, the Court considered whether the insurance carriers properly brought suit under the Tucker Act in the Court of Federal Claims. Although the federal government is immune from suit unless it unequivocally consents, it waived immunity for certain damages suits in the Court of Federal Claims through the Tucker Act. A claim falls within the Tucker Act\u2019s immunity waiver if: (1) the claim \u201ccan fairly be interpreted as mandating compensation by the Federal Government for the damage sustained,\u201d (2) the obligation-creating statute does not provide its own detailed remedies, and (3) the Administrative Procedure Act does not provide an avenue for relief. In this case, the Court found that the insurance carriers\u2019 claim satisfied this test and was thus properly brought under the Tucker Act in the Court of Federal Claims.\u003C\/p\u003E\n\u003Cp\u003EJustices Clarence Thomas and Neil Gorsuch joined the majority opinion except as to the part discussing the legislative history of the appropriations riders.\u003C\/p\u003E\n\u003Cp\u003EJustice Samuel Alito filed a dissenting opinion, arguing that the majority\u2019s decision \u201cinfers a private right of action\u201d where Congress did not expressly create one. Specifically, Justice Alito questioned the test the Court has used (and used in this case) to determine whether a claim may be brought against the United States under the Tucker Act.\u003C\/p\u003E\n","advocates":[{"advocate":{"ID":37772,"name":"Paul D. 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