Moda Health Plan, Inc. v. United States

Tucker Act

Question(s) Presented

“To encourage health insurers to offer insurance on newly created health benefit exchanges, and to keep premiums low, the federal government made an unambiguous statutory commitment: If the costs of claims under these new health insurance policies exceeded the premiums charged in the first three years, the government would reimburse insurers a specified percentage of the difference. Numerous health insurers, including petitioners, relied on that promise, joined the exchanges, set their premiums, and incurred significant losses in providing health coverage. Congress later enacted a series of appropriations riders restricting the sources of funds available to the Department of Health and Human Services (‘HHS’) to pay insurers what was owed, but never amended the underlying statute. A divided Federal Circuit panel agreed that the government’s initial statutory commitment was unambiguous, but relied on legislative history to hold the appropriations riders had repealed the statutory guarantee. The net effect was a bait-and-switch of staggering dimensions in which the government has paid insurers $12 billion less than what was promised. The question presented is: Whether Congress can evade its unambiguous statutory promise to pay health insurers for losses already incurred simply by enacting appropriations riders restricting the sources of funds available to satisfy the government’s obligation.”


“These cases present three questions: First, did §1342 of the Affordable Care Act obligate the Government to pay participating insurers the full amount calculated by that statute? Second, did the obligation survive Congress’ appropriations riders? And third, may petitioners sue the Government under the Tucker Act to recover on that obligation? Because our answer to each is yes, we reverse.”

Proceedings and Orders
February 21, 2019
Blanket Consent filed by Petitioners, Moda Health Plan, Inc., et al..
February 27, 2019
Motion to extend the time to file a response is granted and the time is extended to and including April 8, 2019.
March 8, 2019
Amicus brief of 18 States and the District of Columbia not accepted for filing. (Corrected version submitted)
April 1, 2019
Motion to extend the time to file a response is granted and the time is further extended to and including May 8, 2019.
May 28, 2019
DISTRIBUTED for Conference of 6/13/2019.
June 17, 2019
DISTRIBUTED for Conference of 6/20/2019.
June 24, 2019
Petition GRANTED. The petitions for writs of certiorari in No. 18-1023 and No. 18-1038 are granted. The cases are consolidated, and a total of one hour is allotted for oral argument. VIDED.
June 24, 2019
Because the Court has consolidated these cases for briefing and oral argument, future filings and activity in the cases will now be reflected on the docket of No. 18-1023. Subsequent filings in these cases must therefore be submitted through the electronic filing system in No. 18-1023. Each document submitted in connection with one or more of these cases must include on its cover the case number and caption for each case in which the filing is intended to be submitted. Where a filing is submitted in fewer than all of the cases, the docket entry will reflect the case number(s) in which the filing is submitted; a document filed in all of the consolidated cases will be noted as “VIDED.” (July 17, 2019)
September 13, 2019
SET FOR ARGUMENT on Tuesday, December 10, 2019. VIDED.
October 25, 2019
November 5, 2019
Record from the U.S.C.A. Federal Circuit is electronic and located on Pacer.
April 27, 2020
Judgment REVERSED and case REMANDED. Sotomayor, J., delivered the opinion of the Court, in which Roberts, C. J., and Ginsburg, Breyer, Kagan, and Kavanaugh, JJ., joined, and in which Thomas and Gorsuch, JJ., joined as to all but Part III–C. Alito, J., filed a dissenting opinion. VIDED.
May 29, 2020