On October 21, 2017, attorneys general from eighteen states and the District of Columbia filed their responsive brief in California v. Trump, in which they are seeking an order preventing the Trump administration from halting cost-sharing reduction (CSR) payments reimbursing insurers for reducing cost-sharing for low-income consumers as required by the Affordable Care Act (ACA).
The states reiterate their argument that the text and legislative plan of the ACA demonstrate that Congress appropriated funding for the CSR payments through the ACA's premium tax credit appropriation; they also argue that the insurance markets created by the ACA cannot function on an annual appropriation basis. The states reject the administration's argument that they should seek relief through the CSR payment case pending in the District of Columbia, noting that the D.C. case involves different issues than their case and that both the states and the administration have argued that the D.C. court has no jurisdiction in any event because the House of Representatives lacks standing to sue.
The states describe again the irreparable injuries they will suffer in terms of increased insurance costs, insurer market exits, more uninsured individuals, and increased administrative burdens if the termination of CSR payments is not enjoined. They also argue that a preliminary injunction is necessary to preserve the status quo and to avoid "chaos, uncertainty, and confusion."
Friend-Of-The-Court Briefs
Four amicus briefs were filed in support of the states. The National Health Law Program filed a brief representing Families USA and over two dozen other consumer organizations. The NHELP brief sets forth research into consumer behavior illuminating why premium increases will hurt consumers even in states that take action to ensure that the increases are covered by increased premium tax credits for many consumers. In states that fail to take appropriate action, consumers will be even more disadvantaged. Moreover, termination of CSR payments will induce insurers to try to avoid low-income consumers, as they will get the same premiums from higher-income enrollees without having to reduce cost sharing. The mere threat of CSR payment termination has already driven insurers from exchanges, reducing consumer choice.
The brief describes the situations of particular consumers affected by the confusion and worry caused by the CSR defunding. Finally, in support of the states' argument that President Trump is violating the constitutional requirement that the president take care that the laws be faithfully executed, the brief lists seventeen actions President Trump has taken to undermine the ACA leading up to the cancellation of the CSRs.
A second brief was filed in support of the states by America's Health Insurance Plans, demonstrating that the CSR funding cutoff will in fact do serious, irreparable damage to insurers and the consumers they cover. This brief argues that payments must in fact be made monthly and that an eventual recovery of lost payments in the Court of Claims is not an adequate substitute.
Democratic members of the House of Representatives filed a third amicus brief in support of the states. The legislators assure the court that the intention of the Congress that passed the ACA was to fund the CSR payments from the same appropriation as the premium tax credits, with which they were repeatedly paired in legislative language. Action taken since 2010 has consistently demonstrated that CSR payment funding was appropriated, according to the brief.
A fourth brief supporting the states was filed by Santa Clara County, which is both an insurer and a health care provider. The county argues that it will be injured in both capacities by the administration's action. The American Hospital Association, Catholic Hospital Association, Federation of American Hospitals, and Association of American Medical Colleges jointly filed a brief nominally in support of neither party, but in fact supporting the states' argument that the termination of the payments will cause harm that Congress could not have intended.
Finally, one amicus brief was filed in support of the administration by the House of Representatives. The House reiterates the argument that it made in its D.C. lawsuit against the administration (before the administration switched side) that Congress has never appropriated funding for the cost sharing reductions.
from Health Affairs BlogHealth Affairs Blog http://ift.tt/2xXFo5t
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