Montana: A tiny bit of good news...small contractor stiffed by Trump wins summary judgment!

I received a tip about this early this morning...which, unfortunately, I was unable to scoop anyone with due to being bogged down/caught up with the #TexasFoldEm drama.

As a result, it looks like Shelby Livingston of Modern Healthcare was first to post about it:

Montana insurer wins lawsuit against feds over unpaid cost-sharing reduction payments

Several health insurers have sued the U.S. government over its failure to make cost-sharing reduction payments that help lower healthcare costs for certain consumers. One just scored the first victory. The U.S. Court of Federal Claims ruled in favor of Montana Health Co-op, which sued the federal government for $5.3 million in unpaid cost-sharing reduction payments, finding that the government violated its obligation under the Affordable Care Act when it stopped paying the CSRs in October 2017."

The rest of the article is behind a paywall, but the gist of it is as follows:

  • The contract insurance carriers sign when they offer policies on the ACA exchanges is to cover a chunk of low-income enrollee deductibles, co-pays and other out-of-pocket costs which would normally be the enrollees' responsiblity. These are called Cost Sharing Reductions.
  • The carriers then submit their CSR invoices to the federal government, which is supposed to reimburse the insurance carriers every month.
  • Donald Trump cut off contrctually-required CSR reimbursement payments to insurance carriers last October...and hasn't made any payments since.
  • That means insurance carriers were effectively stiffed for October, November and December CSR payments in 2017...totalling upwards of $2 billion or so collectively.
  • They're also being stiffed out of 2018 CSR reimbursements as well, of course, but they put their heads together with the insurance regulators and came up with the clever #SilverLoading and #SilverSwitching workarounds to make up their losses.
  • However, Silver Loading/Switching doesn't do anything to make up their losses for the last three months of 2017.
  • Therefore, they sued.

In this case, Montana Health Co-Op, which is also, ironically, one of the only ACA-created Co-Op insurers to survive 5 years after starting up, won their case and will supposedly actually be paid the $5.3 million contractually owed to them.

Unless Donald Trump appeals the case, of course, which is pretty likely given that he's never willingly paid a contractor he owes money to in his life.

I may not have scooped anyone, but I do have a copy of the actual legal decision itself, if that's worth anything (see below)...