Health Care

City of Chicago v. Alex M. Azar, II

In City of Chicago v. Azar, the District Court for the District of Columbia considered whether the Trump Administration’s decision not to open a special enrollment period for consumers to purchase health insurance on the federal Exchanges during the COVID-19 pandemic violates the Affordable Care Act (ACA).

Case Summary

The ACA was passed in 2010 with the express objective of achieving “near-universal” healthcare coverage in the United States.  To that end, Congress included a number of provisions aimed at increasing healthcare coverage.  Those measures include the expansion of Medicaid, barring of private insurers from discriminating on the basis of preexisting conditions (among other individual protections), and the creation of health insurance Exchanges through which individual consumers can easily purchase a health insurance plan.  While consumers ordinarily purchase insurance during annual open enrollment periods, the ACA also requires the Department of Health and Human Services (HHS) to open “special enrollment periods” (SEPs) after certain triggering events such as job loss, and in other “exceptional circumstances.”  Pursuant to this provision, nearly all the state-run Exchanges opened SEPs during the COVID-19 pandemic given the severity of the pandemic and the resulting economic contraction.  However, the Trump Administration chose not to open a SEP on the federal Exchanges.  The City of Chicago filed suit in the District Court for the District of Columbia against HHS Secretary Alex Azar II alleging that this decision violates the ACA.

CAC, along with the House General Counsel’s Office, filed an amicus brief on behalf of the U.S. House of Representatives in support of the City of Chicago.  Our brief made three key points.  First, we explained that the ACA was designed to address fundamental flaws in the American healthcare system that left millions of Americans each year underinsured or uninsured.  Second, we explained that the provisions of the ACA aimed at expanding access to coverage have been remarkably successful, reducing the number of uninsured Americans and expanding healthcare benefits to tens of millions of Americans.  A critical part of those reforms was the creation of health insurance Exchanges through which millions of Americans have been able to purchase health insurance for themselves and their families.  Finally, we explained that the Trump Administration’s decision not to open a special enrollment period during the COVID-19 pandemic undermined Congress’s plan in passing the ACA.  Indeed, with a deadly virus magnifying the need for quality, affordable insurance, and with millions of newly unemployed Americans losing employer-sponsored health insurance, the pandemic is a quintessential “exceptional circumstance” that should require HHS to open a SEP.  The Trump Administration, however, declined to do so for seemingly political reasons, and its decision was consistent with a pattern of other actions that undermined the Exchanges.

In February 2021, after the Centers for Medicare and Medicaid Services under the Biden Administration opened an SEP to address the ongoing COVID-19 pandemic, the parties stipulated to dismissal of the case.

Case Timeline

  • June 19, 2020

    CAC and House General Counsel’s Office file an amicus brief on behalf of the U.S. House of Representatives in the District Court for the District of Columbia

    D.D.C. Amicus Brief
  • February 2, 2021

    The parties stipulate to dismissal of the case

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