News & Perspectives

States seek to intervene in House v. Price lawsuit

26. May 2017 Tom Entrikin Health

On May 18, 2017, 15 states and the District of Columbia filed a motion to intervene in House v. Price, a lawsuit threatening the availability of federal funds (about $9 billion in 2017) for cost-sharing reduction (CSR) payments to health insurers under the Affordable Care Act (ACA).  The lawsuit pertains to whether or not CSR payments are subject to annual Congressional appropriations.  It was initially filed in November 2014 in U.S. District Court, which ruled in favor of the U.S. House of Representatives in May 2016, but held its decision in abeyance pending appeal.  It is now before the U.S. Circuit Court of Appeals in the District of Columbia.

The states argue that uncertainty about federal CSR payments has directly impacted them: reduced participation by private insurance companies in individual health insurance markets in many states, less price competition among insurers, and higher costs for some consumers have been seen.  Over time, it could cause the number of uninsured Americans to go back up, hurting vulnerable persons and directly burdening the state and local agencies that serve them.  Most immediately, state agencies face imminent deadlines for the review and approval of 2018 health insurance premiums, an arduous task compounded by uncertainty about CSR payments and the impact that a loss of such payments might have on insurance enrollments and risk pools in each state for 2018.   

CSR payments were designed under the ACA to reduce out-of-pockets costs, such as deductibles and co-payments, for eligible individuals with incomes under 250 percent of the federal poverty level (FPL), who might otherwise be unable to afford care despite premium subsidies available under a separate ACA provision.

As of May 22, 2017, the U.S. House of Representatives (the plaintiff) and the U.S. Department of Justice (on behalf of the defendant, HHS Secretary Thomas E. Price, M.D.) have requested the U.S. Circuit Court of Appeals to continue to hold House v. Price in abeyance for an unspecified period of time.  No decision has yet been made by the court on the states’ May 18, 2017 motion to intervene.