The federal government owes a West Coast health insurance company more than $214 million in Affordable Care Act payments, a judge has ruled.
Moda Health Plan sued the government in June, saying the government owed it “risk corridor” payments from 2014 and 2015. The risk corridor program was intended to pay insurers if they lost money during the first three years of the ACA’s implementation. According to Moda, the government had paid just 12.6% of its claims for 2014 and none at all for 2015.
The government moved to dismiss the case, saying it had until the end of 2017 to make full payment. Since the payments weren’t “presently due,” the government argued the federal claims court lacked jurisdiction. It also argued that the program was required to be budget neutral, and that the government’s obligations had been, in effect, repealed because Congress failed to set aside money for risk corridor payments.
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But Judge Thomas C. Wheeler tossed those claims out, granting Moda a partial summary judgment at the same time.
“There is no genuine dispute that the government is liable to Moda,” Wheeler wrote. “Whether under statute of contract, the court finds that the government made a promise in the risk corridors program that it has yet to fulfill. After all, to say to Moda, ‘The joke is on you. You shouldn’t have trusted us,’ is hardly worthy of our great government.”
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