Supreme Court declines to hear insurers' appeal seeking full reimbursement of CSR payments

The Supreme Court declined to hear an appeal from two insurers that sought to get the full amount they are owed in federal cost-sharing reduction payments.

The court declined Monday an appeal from Maine Community Health Options and Community Health Choice over an appellate court decision that plans that engaged in “silver loading” are not eligible to be repaid for lost CSR payments.

The court did not give a reason for not taking up the case, but the decision deals a blow to insurers looking to recoup CSR payments they believe they are owed by the federal government.

The Supreme Court had previously ruled in April 2020 that the federal government had to fully repay insurers for risk-corridor payments under the Affordable Care Act (ACA). The court ruled insurers were entitled to more than $12 billion in unpaid payments.

The risk corridor program ran from 2014 to 2016. It guaranteed payments to ACA exchange insurers that recorded certain losses. The goal was to help insurers navigate the new exchanges that went online in 2014.

RELATED: Experts see robust participation for ACA exchanges after SCOTUS win, temporary boost to subsidies

However, the needed payments increased as the initial population on the ACA’s exchanges was sicker than usual, and plans were priced too low.

A few months later, in August, the Court of Appeals for the Federal Circuit decided that the Supreme Court ruling meant CSR payments were mandatory, too. However, the court ruled plans that engaged in the practice of “silver loading” were not entitled to full payments.

“Silver loading” occurred in response to former President Donald Trump’s decision in 2017 to stop reimbursing insurers for CSR payments. Insurers are required to offer the CSRs to help low-income ACA customers lower cost sharing, but the government had reimbursed them before Trump’s decision.

Plans in response employed “silver loading” where they added the cost of CSRs to the second-cheapest silver plan, which is also the benchmark plan that the federal government pegs subsidies to. The result of “silver loading” was that subsidies went up because the benchmark plan’s cost increased.

Maine Community Health Options and Community Health Choice had argued before the appellate court that the Supreme Court ruling set a precedent that also impacted the CSR payments.