Federal Circuit: Insurers Owed Unpaid Cost-Sharing Reductions, Reduced By Higher Premium Tax Credits From Silver Loading

On August 14, 2020, a three-judge panel of the Court of Appeals for the Federal Circuit issued two decisions—Sanford Health Plan v. United States and Community Health Choice v. United States—concluding that insurers are entitled to unpaid cost-sharing reductions (CSRs) under Section 1402 of the Affordable Care Act (ACA). The Federal Circuit agreed with the lower courts that Section 1402 imposes an “unambiguous obligation” on the government to make CSR payments to insurers and that this obligation is enforceable for damages in court. However, the panel differed with the lower courts on damages and limited the amount of unpaid CSRs that insurers can recover based on premium loading.

Both decisions were unanimous and heard by Judges Richard G....

Today's Sponsors

Today's Sponsor