Health Care

United States House of Representatives v. Price

In United States House of Representatives v. Price, the United States Court of Appeals for the District of Columbia Circuit is considering whether the executive branch acted lawfully when it reimbursed health care insurers for cost-sharing reductions as it was required to by the Patient Protection and Affordable Care Act (“ACA”), as well as whether the House of Representatives has standing to bring this lawsuit against the executive branch in the first place.

Case Summary

The ACA was designed to achieve near-universal health insurance coverage. Critical to ensuring that both health insurance and health care would be affordable for low- and middle-income Americans, the ACA created two complementary benefits: premium tax credits to help make insurance affordable, and subsidies to reduce cost-sharing (e.g., deductibles and copayments) to help make health care affordable. Although the ACA mandates that the federal government reimburse insurers for these cost-sharing reductions, and the Obama Administration enforced the mandate, House leadership in 2014 filed a lawsuit in the United States District Court for the District of Columbia, alleging that there was no appropriation to fund these mandatory reimbursement payments. On December 8, 2015, Constitutional Accountability Center filed a friend-of-the-court brief on behalf of Democratic leaders in the House, including Rep. Nancy Pelosi, in support of the Administration.

On May 12, 2016, the D.C. District Court ruled against the Administration, holding that the House has standing to bring its claim, and holding that there was no appropriation for the reimbursement of insurers for the cost-sharing reductions required by the ACA. The District Court stayed its decision pending appeal, and the Administration filed an appeal.

On October 31, 2016, as we did in the lower court, CAC filed a friend-of-the-court brief on behalf of the House Democratic leaders, urging the Court of Appeals to reverse the District Court’s decision. Our brief first argues that the House of Representatives does not have standing to bring this case and that this dispute should be resolved not through the courts, but through traditional legislative and executive processes. As we explain in the brief, legislators’ allegations that a member of the executive branch has not complied with a statutory requirement, which is all the House alleges here, do not establish the sort of “concrete and particularized” injury sufficient to satisfy Article III’s standing requirements. Indeed, allowing suit here would encourage lawsuits over a virtually limitless number of inter-branch or partisan disputes traditionally resolved outside of the courts. Further, as our brief explains, Congress has numerous tools at its disposal to resolve routine disputes over the scope of applicable spending authority such as this one.

Our brief then turns to the merits and explains that, as the legislators filing this brief know from their involvement in the debates and deliberations over the ACA in Congress, both the premium tax credits and the cost-sharing reductions are critical to the effective operation of the ACA’s legislative plan. The law therefore established a unified system for payment of both the tax credits and the cost-sharing reductions, and it funds them both out of the same permanent appropriation. Further, as the brief explains, subsequent actions by Congress served to confirm what everyone understood at the time the ACA was enacted: there is a permanent appropriation that funds both the tax credits and the cost-sharing reduction subsidies that are at issue in this case.

On November 23, 2016, shortly after the presidential election, the House of Representatives filed a motion requesting that the Court hold the case in abeyance, which the Court granted on December 5, 2016 over the opposition of the Department of Justice. The Court also ordered the parties to file motions to govern future proceedings on February 21, 2017. On that date, the House and the new Trump Administration Department of Justice filed a joint motion, asking the Court to continue to hold the case in abeyance “to allow time for a resolution that would obviate the need for judicial determination of this appeal, including potential legislative action.” The Court granted the motion and ordered that the parties file status updates at 90-day intervals. In the parties’ first status update, filed on May 22, 2017, they asked the Court to continue to hold the case in abeyance.

Meanwhile, on May 18, 2017, 16 state Attorneys General filed a motion to intervene in the case, on the grounds that the Trump Administration no longer adequately represents the states’ interests. On August 1, 2017, the Court granted the motion. As the Court explained, the states had “shown a substantial risk that an injunction requiring termination of the [cost-sharing reduction] payments . . . would lead directly and imminently to an increase in insurance prices, which in turn will increase the number of uninsured individuals for whom the States will have to provide health care.” The Court also concluded that the states “have raised sufficient doubt concerning the adequacy of the [Department of Justice’s] representation of their interests.” The Court is still holding the case in abeyance, and the parties are required to submit updates to the court on a regular basis.

On December 15, 2017, a settlement was agreed to which dismissed the appeal and dissolved the injunction of the lower court.

Case Timeline

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