The Obama administration made news on Friday afternoon when it announced that it was open to discussing settlements with health plans that have sued the administration over risk corridor payments: As in any lawsuit, the Department of Justice is vigorously defending those claims on behalf of the United States. However, as in all cases where […]
In a January memo to Senator Rubio, the Congressional Research Service laid out an argument for why the Obama administration can’t use the Judgment Fund to settle risk corridor lawsuits. (For prior coverage, see my posts here.) I think CRS is mistaken, and it’s worth explaining why—even if it means getting deep into the weeds […]
Aetna has denied any link between the Justice Department’s effort to block its merger with Humana and the company’s departure from the exchanges. Turns out those denials are not so true. Jonathan Cohn and Jeff Young at the Huffington Post have unearthed a letter from Aetna’s CEO to the Justice Department before the antitrust suit […]
Some people have asked me why I’ve been so hard on the administration for flouting appropriations law over the ACA’s cost-sharing reductions. Hasn’t the administration done the right thing to try to prevent health reform from collapsing? Aren’t the Republicans being hopelessly intransigent? Shouldn’t I just shut up? I hear all that. I’m a committed […]
Last Friday, the D.C. Circuit rejected West Virginia’s challenge to the so-called “like it, keep it” fix, which told the states that they could temporarily decline to enforce the ACA’s new insurance rules against their insurers. (Background here.) I’m sympathetic to West Virginia’s underlying legal claim. It was unlawful, in my judgment, for the Obama […]
Last week, the Department of Justice asked the Court of Federal Claims to dismiss a massive class-action lawsuit in which co-ops have asked for money owed to them under the risk corridor program. To my knowledge, the government’s motion is its first substantive filing in any of the risk corridor cases. The litigation was precipitated […]
Dan Ho and Becky Elias have a wonderful article in the Boston Review about their new research on the benefits of peer review in restaurant inspections. Beginning in 2014, we designed a randomized, controlled trial to test the effectiveness of peer review with the food safety staff of King County, where Seattle is located. Half […]
Yesterday, the Supreme Court decided a False Claims Act suit that has enormous implications for Medicare and Medicaid fraud. The allegations in Universal Health Services v. United States ex rel. Escobar are startling. Yarushka Rivera, a young Medicaid beneficiary, died of an adverse reaction to medication that she’d received to treat her bipolar disorder. After […]
If you’re one of the six people left who still hasn’t had enough of ACA litigation, you’re in luck. Yesterday, a health plan in Maryland sued the Centers for Medicare and Medicaid Services, arguing that it has botched the implementation of the risk adjustment program. The risk adjustment program is one of the three R’s—reinsurance, […]
By my count, health plans have filed five separate lawsuits in the Court of Federal Claims seeking money that they’re owed under the risk corridor program. As I’ve explained here and here, I think the lawsuits have merit, which is why I expect to see a lot more of them. If you’re a health plan, […]
I have a new piece at the New England Journal of Medicine siding with the district court on the merits of the appropriations dispute between the House of Representatives and the Obama administration. Here’s a taste:2 The problem with the administration’s argument is that, by statute, a law “may be construed to make an appropriation […]
It was only a matter of time. Last Friday, a federal judge in Washington State entered a preliminary injunction ordering the state’s Medicaid program to pay for direct-acting antivirals—think Harvoni or Sovaldi—for any beneficiary diagnosed with Hepatitis C. Like many states, Washington has a policy of refusing to supply the drugs until the disease has […]
From Ron Klain, the former Ebola czar, in the Washington Post: If it seems like the world is being threatened by new infectious diseases with increasing frequency—H1N1 in 2009-2010, MERS in 2012, Ebola in 2014, Zika in 2016, yellow fever on the horizon for 2017—that’s because it is. These are not random lightning strikes or […]
Don’t panic about House v. Burwell. From the New York Times on what might happen if the House prevails in House v. Burwell: A study by the Department of Health and Human Services estimated that premiums for midlevel “silver plans” could rise by nearly 30 percent without [cost-sharing] reimbursements. Many consumers would be protected, since […]
Having previously held that the House of Representatives has standing to sue, the district court in House v. Burwell has now held that the Obama administration is violating the Appropriations Clause in making cost-sharing payments under the ACA in the absence of the requisite congressional appropriation. The court has stayed its decision pending appeal, meaning […]