This morning the Federal Circuit issued two precedential opinions in Tucker Act cases and one nonprecedential order denying a writ of mandamus. Here are the introductions to the opinions and text from the order.

Sanford Health Plan v. United States (Precedential)

In the Patient Protection and Affordable Care Act (the ACA), Pub. L. No. 111-148, 124 Stat. 119 (2010), as amended, Congress directed each State to establish an online exchange through which insurers may sell health plans if the plans meet certain requirements. One such requirement is that insurers must agree to reduce the “cost-sharing” burdens—such as the burdens of making co-payments and meeting deductibles—of certain of their customers. When insurers meet that requirement, the ACA says, the Secretary of Health and Human Services (HHS) shall reimburse them for the required cost-sharing reductions they have provided to their customers. 42 U.S.C. § 18071(c)(3)(A) (“the Secretary shall make periodic and timely payments to the issuer equal to the value of the reductions”). This reimbursement seeks to make the insurers whole for the increased payments they make to healthcare providers when customers do not pay the providers unreduced cost-sharing amounts. 

In October 2017, the Secretary stopped making reimbursement payments, due to determinations that such payments were not within the congressional appropriation that the Secretary had, until then, been invoking to pay the reimbursements. In January 2018, Sanford Health Plan— a seller of insurance through the North Dakota, South Dakota, and Iowa exchanges—and Montana Health CO-OP— a seller of insurance through the Montana and Idaho exchanges—brought materially identically actions against the United States in the Court of Federal Claims. The two plaintiffs alleged that they were entitled to damages because the government had violated its statutory obligation—or, in the alternative, breached an implied-in-fact contract—by failing to reimburse them for the cost-sharing reductions they made during the final months of 2017. 

The trial court granted summary judgment for the plaintiffs. Sanford Health Plan v. United States, 139 Fed. Cl. 701 (2018); Montana Health CO-OP v. United States, 139 Fed. Cl. 213 (2018). In materially identical opinions, the court concluded that the ACA provision on reimbursement of cost-sharing reductions is “money-mandating” and that the government is liable for money damages for its failure to make reimbursements for the 2017 reductions. Sanford, 139 Fed. Cl. at 702, 706–09; Montana, 139 Fed. Cl. at 214, 218–21. The court did not reach the contract claim in either case. Sanford, 139 Fed. Cl. at 704 n.4; Montana, 139 Fed. Cl. at 216 n.4. Based on stipulations as to the amounts due, the court ultimately entered final judgments of $360,254.00 for Sanford and $1,234.058.79 for Montana. 

The government appeals. We consolidated the appeals, and we now affirm. After initial briefing and argument, the Supreme Court decided Maine Community Health Options v. United States, 140 S. Ct. 1308 (2020), addressing a different payment-obligation provision of the ACA. We conclude that Maine Community makes clear that the cost-sharing-reduction reimbursement provision imposes an unambiguous obligation on the government to pay money and that the obligation is enforceable through a damages action in the Court of Federal Claims under the Tucker Act, 28 U.S.C. § 1491(a)(1). We see no persuasive basis for distinguishing these cases from Maine Community

Community Health Choice, Inc. v. United States (Precedential)

Today in Sanford Health Plan v. United States (“Sanford”), No. 19-1290, we hold that the United States failed to comply with section 1402 of the Patient Protection and Affordable Care Act (“ACA”), Pub. L. No. 111-148, 124 Stat. 119, 220–24 (2010) (codified at 42 U.S.C. § 18071)—which requires the government to reimburse insurers for “cost-sharing reductions.” We hold that section 1402 “imposes an unambiguous obligation on the government to pay money and that the obligation is enforceable through a damages action in the Court of Federal Claims [(‘Claims Court’)] under the Tucker Act.” Sanford, No. 19-1290, slip op. at 3. 

In these cases, following our decision in Sanford, we affirm the Claims Court’s decisions as to liability. As in Sanford, we conclude that the government is not entitled to a reduction in damages with respect to cost-sharing reductions not paid in 2017. As to 2018, we address an issue not presented in Sanford: the appropriate measure of damages. We hold that the Claims Court must reduce the insurers’ damages by the amount of additional premium tax credit payments that each insurer received as a result of the government’s termination of cost-sharing reduction payments. We reverse and remand for further proceedings with respect to damages. 

In re Wilkins (Nonprecedential Order)

In General Electric Co. v. Wilkins, 750 F.3d 1324 (Fed. Cir. 2014), this court affirmed the judgment of the United States District Court for the Eastern District of California that Thomas Wilkins was not a co-inventor of U.S. Patent No. 6,921,985. Mr. Wilkins now petitions this court for a writ of mandamus to vacate, reverse, or dismiss various rulings in that and other related closed appeals and in the closed underlying district court proceedings.

Mr. Wilkins’ petition appears to be an attempt to relitigate that prior litigation concerning his inventorship dispute with GE. Mr. Wilkins lost the first time around on the issues that he seeks review, and mandamus is not intended to afford him a second bite of the appellate apple. Cf. Roche v. Evaporated Milk Ass’n, 319 U.S. 21, 26 (1943) (explaining that mandamus is not a substitute for an appeal). Because Mr. Wilkins clearly does not have a right to the relief he seeks, the court denies his petition. 



The petition is denied.