payments were made, the other to apply if they were not.
174
See, e.g., RABAH KAMAL ET AL., KAISER FAMILY FOUND., HOW THE LOSS OF COST-SHARING
SUBSIDY PAYMENTS IS AFFECTING 2018 PREMIUMS (2017), https://www.kff.org/health-reform/issue-
brief/how-the-loss-of-cost-sharing-subsidy-payments-is-affecting-2018-premiums/ [https://perma.cc/
5N8A-36WD].
In October 2017, the Administration halted the payments entirely.
175
See Notice at 1, United States House of Representatives v. Hargan, No. 16-5202 (D.C. Cir. Oct.
13, 2017), https://separationofpowerslaw.files.wordpress.com/2017/12/us-house-v-hargan-sessions-
opinion-letter.pdf [https://perma.cc/N524-TAUP].
Seventeen states sued in the Northern District of California to get a preliminary
injunction to reverse the decision.
176
They were unsuccessful, partly because
most states, including California, had already raised insurers’ overall rates in
order to compensate for the loss of CSR payments.
177
The court held that, without
irreparable harm to the insurers, a preliminary injunction was inappropriate.
178
A number of insurers then filed cases in the Court of Federal Claims seeking
reimbursement for CSR payments that the federal government had not made.
179
So far, the Court of Federal Claims has ruled in favor of the insurers in six cases.
The most significant ruling came in Common Ground, an opt-in class action,
where on October 22, 2019, the court entered a $1,587,108,397.81 judgment for
the 2017 and 2018 plan years.
180
Several CSR cases were appealed to the Federal
Circuit, which held oral argument on January 9, 2020.
181
Other CSR cases are
174.
175.
176. California v. Trump, 267 F. Supp. 3d 1119 (N.D. Cal. 2017). The states seeking preliminary
included California, Connecticut, Delaware, Illinois, Maryland, Massachusetts, Minnesota, Vermont,
Oregon, Pennsylvania, New York, Washington, Virginia. Id. at 1121. The District of Columbia, Iowa,
Kentucky, and New Mexico joined pro se. Id.
177. Id. at 1134–38. The states generally used a practice known as “silver loading”—shifting the
weight of the rate increases into the ACA’s middle level, silver plans, which are subsidized. The effect is
that the individual subsidized purchaser does not feel the effect of the rate increase, because the federal
subsidy increases as the silver rate does (meaning, ironically, that the federal government winds up
paying at least as much to the plans as it would have done if it had made the CSR payments in the first
place).
178. Id. at 1134–39.
179. See, e.g., Complaint, Emblemhealth, Inc., v. United States, No. 19-1164-C (Fed. Cl. Aug. 12,
2019); Complaint, Common Ground Healthcare Coop. v. United States, 142 Fed. Cl. 38 (2019), appeal
filed, No. 20-1286 (Fed Cir. Dec. 23, 2019); Complaint, Noridian Mutual Ins. Co. v. United States, No.
18-1983-C (Fed. Cl. Dec. 27, 2018); Complaint, Local Initiative Health Authority for Los Angeles Cty.
v. United States, 145 Fed. Cl. 746 (2018); Complaint, Sanford Health Plan v. United States, 139 Fed. Cl.
701 (2018), appeal filed, No. 19-1290 (Fed Cir. Dec. 11, 2018); Complaint, Blue Cross & Blue Shield of
Vt. v. United States, No. 18-373-C (Fed. Cl. Mar. 9, 2018); Complaint, Health All. Med. Plans, Inc. v.
United States, No. 18-334-C (Fed. Cl. Mar 5, 2018); Complaint, Mont. Health Co-Op v. United States,
139 Fed. Cl. 213, appeal filed, No. 19-1302 (Fed. Cir. Dec. 12, 2018); Complaint, Molina Healthcare of
Ca., Inc., v. United States, 133 Fed. Cl. 14 (2017).
180. Common Ground Healthcare Coop. v. United States, No. 1:17-cv-877-MMS, slip op. at 1 (Fed.
Cl. Oct. 22, 2019).
181. In ascending order of Federal Circuit docket number, they are Sanford Health Plan, 139 Fed. Cl.
70 (2018), appeal docketed, No. 19-1290 (Fed Cir. Dec. 11, 2018); Montana Health Co-Op, 139 Fed. Cl.
213, appeal docketed, No. 19-1302 (Fed. Cir. Dec. 12, 2018); Community Health Choice, 141 Fed.
Cl. 744 (2019), appeal docketed, No. 19-1633 (Fed. Cir. March 8, 2019); Common Ground Healthcare
Cooperative, 142 Fed. Cl. 38 (2019), appeal docketed, No. 20-1286 (Fed Cir. Dec. 23, 2019); and Local
Initiative Health Authority for Los Angeles County, 145 Fed. Cl. 746 (2019), appeal docketed, No. 20-1393
(Fed. Cir. Jan. 27, 2020). The United States raised complex damages-computation issues, and asks whether
2020] THE AFFORDABLE CARE ACT’S LITIGATION DECADE 1499