Maine Community Health Options v. United States

The Patient Protection and Affordable Care Act’s expired “Risk Corridors” program established a money-mandating obligation and Petitioners properly relied on the Tucker Act to recover from the United States for its failure to reimburse them.

The Patient Protection and Affordable Care Act (“ACA”) includes several risk-mitigation programs including the temporary “Risk Corridors” program.  For the first three years, providers with profits above a certain threshold would pay the United States while those with losses below that threshold would receive payments from the U.S. in accordance with the formula set in § 1342 of the ACA.  Petitioners, four participating insurance companies, sued the U.S. in the Court of Federal Claims for its failure to reimburse them under the “Risk Corridors” program.  Invoking the Tucker Act, 28 U.S.C. § 1491, Petitioners alleged that § 1342 obligated the U.S. to pay the full amount of their losses as calculated by the statutory formula.  In the trial courts, only one Petitioner prevailed and the Court of Appeals for the Federal Circuit ruled for the U.S. in each appeal.  The Supreme Court held that the Risk Corridors program established a valid yet unfulfilled U.S. obligation to make payments under § 1342’s formula.  Emphasizing the importance of U.S. credibility in public-private enterprise, the Court reasoned that the plain terms of the provision created an obligation irrespective of the availability of appropriations, Congress did not expressly repeal this obligation, and neither strand of the Court’s implied-repeal precedent applied.  The Court found that Petitioners properly relied on the Tucker Act to recover.  REVERSED AND REMANDED.