- Highmark, a major insurer in, the Pennsylvania, Delaware and West Virginia exchanges, has filed suit against the federal government over its failure to come through on its mandatory risk corridor obligations prescribed under the ACA, The Wall Street Journal reported.
- The insurer is seeking the remainder of the money it is owed from 2014 through the program, which amounts to about $196 million of the original $223 million.
- The lawsuit comes at a particularly contentious time for the ACA. In the past week alone came a ruling that Obama's administration overstepped its authority by making payments without specific appropriations from Congress, the Journal noted.
HHS revealed last fall -- too late in the game for those counting on the funding -- that it would initially pay insurers just 12.6% of the risk-corridor funds claimed for 2014. While HHS has said full payment would be made over additional years as more funds become available, that is of little use to insurers in need of timely payment.
The unpaid risk corridors money has been blamed as a factor in the failure of many of the ACA's health co-ops and the difficulty some insurers are encountering in managing their losses in the ACA markets.
Highmark is also asking the government to cover interest and legal expenses, and asks the court that if it decides for Highmark, the same ruling be applied to risk-corridor payments for 2015 and 2016.
The insurer's case is expected to draw significant attention because of its high-profile role in multiple ACA marketplaces. Meanwhile, a related case is already in progress. Oregon's Health Republic Insurance, which is no longer enrolling members, is seeking class action status for its suit claiming the federal government withheld funds through the risk corridors program.