Minuteman Health Sues Over Obamacare — Again

BOSTON, MA — A Boston-based health insurer is once again suing over the Affordable Care Act program, better known as Obamacare.

Minuteman Health filed suit Wednesday against the federal government, attempting to collect the $5.5 million in payments Minuteman says it is owed through the Affordable Care Act’s Risk Corridor program from 2014, as well as its estimated total owed in 2015.

That program was originally designed to reduce the risk insurers take on when offering qualified health plans in the ACA marketplaces during the first three years.

In September, the agency in charge of the ACA announced it will pay nothing toward that amount in 2015, due to a shortfall in 2014, after not enough health insurers paid into the program. It will spend the 2015 collections paying off its 2014 obligations to insurers, plans to use 2016 funding to pay off its 2015 obligations, and so on.

According to Minuteman, those successive shortfalls have left it and other insurance companies in the lurch.

Per the lawsuit, Risk Corridor and Risk Adjustment aspects of Obamacare are designed to offset one another; Minuteman pays the government, and the government in turn balances those payments to mitigate insurers' risks.

“The Government, however, has rejected this basic common sense approach, instead applying a double standard: Minuteman must meet its payment obligations, but the Government need not make good on its debts,” the lawsuit states.

According to Minuteman, the government has paid it and other issuers 12.6 percent or less of Risk Corridor amounts due for 2014.

The government has said it hopes to obtain funding through Congress to offset the shortfalls. It will also, however, continue to defend against lawsuits like Minuteman's.

"We know that a number of issuers have sued in federal court seeking to obtain the risk corridors amounts that have not been paid to date. 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 there is litigation risk, we are open to discussing resolution of those claims," a press release this September from the Centers for Medicare and Medicaid Services said.

In a press release of its own, Minuteman General Counsel and Chief Administrative Officer Susan Brown said the federal government has been inconsistent at best in fulfilling its commitments through the ACA.

“One minute the federal government is promising to fulfill its requirements under the risk corridor statute. Then the government changes its mind and says it won’t. It is no wonder that premiums are going up in this unstable, unpredictable environment,” she said in a statement.

According to the Boston Business Journal, who first reported Wednesday's suit, Minuteman previously filed a lawsuit against the federal government in July over the ACA's “risk adjustment" program.

Minuteman Health, Inc. is a non-profit health maintenance organization (HMO) that serves both Massachusetts and New Hampshire.

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