If these decisions hold up through a potential appeals process, they could result in the federal government owing billions of dollars annually until Congress makes an explicit appropriation or otherwise changes the law.
Federal judges issued four new rulings late last week in favor of insurers who argue the government owes them cost-sharing reduction (CSR) payments under the Affordable Care Act despite the Trump administration's 2017 decision to halt them abruptly.
Since one of the cases is a class action involving 91 insurers, the total number of insurers that have won their CSR cases is nearly 100. These cases could represent billions of dollars annually.
In a blog post on Sunday, HealthAffairs' Katie Keith wrote that she is aware of 12 separate lawsuits that insurers have filed against Health and Human Services for the unpaid CSR dollars. Half of the cases have been decided, all of them in favor of the insurers.
Court of Federal Claims Judge Thomas C. Wheeler decided a case involving L.A. Care Health Plan last Thursday, finding that the insurer was owed about $6 million for the 2017 plan year.
Judge Margaret M. Sweeney issued decisions on three cases last Friday: Common Ground Healthcare (the class action), Maine Community Health Options, and Community Health Choice.
"If their decisions stand, insurers could recover roughly $12 billion a year, every year, until Congress intervenes to stop the bleeding," University of Michigan law professor Nicholas Bagley wrote for The Incidental Economist.
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Related: Judge Dismisses California's Lawsuit Over Halted Cost-Sharing Payments
The story was previously reported by Inside Health Policy's Amy Lotven.
Steven Porter is an associate content manager and Strategy editor for HealthLeaders, a Simplify Compliance brand.