Blue Cross and Blue Shield of North Carolina sued the federal government, becoming the latest health insurer to claim it is owed money under the Affordable Care Act. The suit, filed on Thursday in the U.S. Court of Federal Claims in Washington, D.C., says the U.S. failed to live up to obligation to pay the insurer more than $147 million owed under an ACA program known as “risk corridors,” which aimed to limit the financial risks borne by insurers entering the new health-law markets.
The suit argues that the federal government violated the language of the health law, as well as a contractual obligation to the North Carolina insurer. Blue Cross and Blue Shield of North Carolina says it’s owed money. ENLARGE Blue Cross and Blue Shield of North Carolina says it’s owed money. Photo: Zuma Press
The suit follows a similar one filed last month by Highmark Health’s insurance arm, and an earlier one in February from Health Republic Insurance Co., which is seeking class-action status.
The move signals the Obama administration is likely to face a growing legal challenge from insurers seeking risk-corridor payouts, as the 2010 health law continues to generate court battles on a number of different fronts.
Blue Cross Blue Shield insurers such as the North Carolina nonprofit and Pittsburgh-based Highmark are backbones of the law’s insurance marketplaces, with the largest enrollments in many states’ exchanges. But many of them have run up significant losses on the ACA plans, causing a financial squeeze.
Blue Cross and Blue Shield of North Carolina said it lost more than $400 million on ACA products in 2014 and 2015 and the risk-corridor payment shortfall exacerbated the losses.
The federal Department of Health and Human Services announced last fall that insurers initially would receive only 12.6% of the money they claimed under the risk-corridor program for 2014, its first year of operation, though federal officials said the insurers would receive more later. The program was supposed to bolster insurers suffering losses by using payments from other insurers that did relatively well on the new ACA business. However, the amount owed was far greater than the sum collected.
According to the suit, federal officials initially signaled that payments would be made even if the inflows weren’t sufficient, but they later said the program would be “budget neutral,” a stance reinforced by Congress in a 2014 spending bill.
A Health and Human Services spokesman didn’t have an immediate comment.
As damages, Blue Cross and Blue Shield of North Carolina is seeking the amount it says it is owed for 2014 under the risk-corridor program, which is more than $147 million, minus the amount it has been paid so far, which is currently around $18 million. The North Carolina insurer also is seeking interest and legal expenses.
The North Carolina insurer also wants the court to force the U.S. to make risk-corridor payments when they are due for later years, and the insurer estimates that it will be owed more than $175 million for 2015.
The suit says that federal plans to backfill the payments owed for 2014 over time, as risk-corridor funds come in for later years, “is contrary to the nature, purpose, intent and language” in the health law.
