Blue Cross and Blue Shield of Kansas City Welfare v. United States

Court of Appeals for the Federal Circuit·Decided July 17, 2026·No. 24-2317·Unpublished

Opinion

NOTE: This disposition is nonprecedential.

United States Court of Appeals for the Federal Circuit

BLUE CROSS AND BLUE SHIELD OF KANSAS CITY WELFARE BENEFIT PLAN, LOUISIANA HEALTH SERVICE & INDEMNITY COMPANY WELFARE BENEFIT PLAN, HOSPITAL AND MEDICAL PLAN FOR BLUECROSS BLUESHIELD OF SC, THE CAREFIRST FLEXIBLE BENEFITS PLAN, COOK GROUP HEALTH PLAN, LESTER E.

COX MEDICAL CENTER WELFARE BENEFIT GROUP INSURANCE PLAN, HUMANA BENEFIT PLANS, HYATT CORPORATION WELFARE PLAN, UNITEDHEALTH GROUP EMPLOYEE HEALTH BENEFIT PLAN, HEALTH CARE SERVICE CORPORATION MASTER FLEXIBLE BENFIT PLAN, HEALTHCARE SERVICE CORPORATION EMPLOYEES WELFARE PLAN, AETNA INC.

MEDICAL DENTAL BENEFIT PLAN, UNITEDHEALTH GROUP POST-EMPLOYMENT MEDICAL PLAN, THE BOARD OF TRUSTEES OF THE CARPENTERS HEALTH AND WELFARE TRUST FUND FOR CALIFORNIA, THE CARPENTERS HEALTH AND WELFARE TRUST FUND FOR CALIFORNIA,

Plaintiffs-Appellants

v.

UNITED STATES, Defendant-Appellee

2 BLUE CROSS AND BLUE SHIELD OF KANSAS CITY WELFARE v. US

2024-2317, 2025-1027

Appeals from the United States Court of Federal Claims in Nos. 1:23-cv-00641-EMR, 1:23-cv-00642-EMR, 1:23-cv-00643-EMR, 1:23-cv-00644-EMR, 1:23-cv-00645- EMR, 1:23-cv-00647-EMR, 1:23-cv-00648-EMR, 1:23-cv- 00650-EMR, 1:23-cv-00651-EMR, 1:23-cv-01282-EMR, 1:23-cv-01455-EMR, 1:23-cv-01491-EMR, Judge Eleni M. Roumel.

Decided: July 17, 2026

AMANDA SHAFER BERMAN, Crowell & Moring, LLP, Washington, DC, argued for all plaintiffs-appellants. Plaintiffs-appellants Aetna Inc. Medical Dental Benefit Plan Blue Cross and Blue Shield of Kansas City Welfare Benefit Plan Carefirst Flexible Benefits Plan Cook Group Health Plan Health Care Service Corporation Master Flexible Benefit Plan Healthcare Service Corporation Employees Welfare Plan Hospital and Medical Plan for Bluecross Blueshield of SC Humana Benefit Plans Hyatt Corporation Welfare Plan Lester E. Cox Medical Center Welfare Benefit Group Insurance Plan Louisiana Health Service & Indemnity Company Welfare Benefit Plan UnitedHealth Group Employee Health Benefit Plan UnitedHealth Group Post- Employment Medical Plan also represented by CHARLES BAEK, STEPHEN JOHN MCBRADY, ISSAC D. SCHABES.

MICHAEL KORDA, Kraw Law Group, Mountain View, CA, for plaintiffs-appellants Board of Trustees of the Carpenters Health and Welfare Trust Fund for California, Carpenters Health and Welfare Trust Fund for California.

SIMON GREGORY JEROME, Appellate Staff, Civil Division , United States Department of Justice, Washington,

BLUE CROSS AND BLUE SHIELD OF KANSAS CITY WELFARE v. US 3

DC, argued for defendant-appellee. Also represented by YAAKOV ROTH, CHARLES W. SCARBOROUGH.

Before DYK, REYNA, and TARANTO, Circuit Judges.

REYNA, Circuit Judge.

Blue Cross and Blue Shield of Kansas City Welfare Benefit Plan and other self-insured group health plans sued the United States government alleging an illegal exaction in violation of the Fifth Amendment. The group health plans alleged that they were improperly required to contribute funds to the Patient Protection and Affordable Care Act’s Transitional Reinsurance Program, 42 U.S.C. § 18061, and later were illegally denied a refund of those contributions. The United States Court of Federal Claims consolidated the cases and dismissed all the complaints for lack of subject-matter jurisdiction because their claims were time-barred under the applicable six-year statute of limitations, 28 U.S.C. § 2501. We affirm.

BACKGROUND

A. Transitional Reinsurance Program Congress enacted the Patient Protection and Affordable Care Act (“Affordable Care Act”) to increase the number of Americans covered by health insurance and decrease the cost of health care. This appeal focuses on section 1341 of the Affordable Care Act, known as the Transitional Reinsurance Program. See generally 42 U.S.C. § 18061. The Transitional Reinsurance Program was intended to stabilize healthcare premiums for individuals during the early years of the Affordable Care Act, specifically from 2014 to 2016.

4 BLUE CROSS AND BLUE SHIELD OF KANSAS CITY WELFARE v. US

Under the Transitional Reinsurance Program, “health insurance issuers, 1 and third party administrators 2 on behalf of group health plans,” 3 were required to make payments to a reinsurance entity during a three-year period from 2014 to 2016. 42 U.S.C. § 18061(b)(1)(A). Reinsurance refers generally to a financial arrangement where an insurer transfers part of its risk to another entity, called the reinsurer or reinsurance entity. The reinsurance entity uses the collected funds to make reinsurance payments to health insurance issuers that cover high-risk patients. 42 U.S.C. § 18061(b)(1)(B), (b)(4).

Section 1341 did not specify the entity that would be responsible for contributing to the Transitional Reinsurance Program., i.e., the “contributing entity.” The Affordable Care Act authorized the U.S. Department of Health and Human Services (“HHS”) to promulgate regulations to carry out the Transitional Reinsurance Program. 42 U.S.C. § 18041(a). Under this authority, HHS promulgated a regulation defining “contributing entity” to clarify the entity required to make contributions under the Transitional Reinsurance Program.

In 2013, HHS defined “contributing entity” as “a health insurance issuer or self-insured group health plan” where a “self-insured group health plan is responsible for the reinsurance contributions, though it may elect to use a third party administrator or administrative services only

1 “Health insurance issuer” generally means an insurance company. See 42 U.S.C. § 300gg-91(b)(2).

2 “Third party administrator” generally means an entity that provides administrative support, such as claims processing, to health insurance issuers.

3 “Group health plan” generally means an employee welfare benefit plan that provides medical care to employees or their dependents. See 42 U.S.C. § 300gg-91(a)(1).

BLUE CROSS AND BLUE SHIELD OF KANSAS CITY WELFARE v. US 5

contractor for transfer of the reinsurance contributions.” Final Rule, 78 Fed. Reg. 15410, 15525 (Mar. 11, 2013).

In 2014, HHS modified the definition of “contributing entity” to exclude self-administered plans, i.e., a group health plan that does not use a third-party administrator. HHS explained that “the better reading of section 1341 is that a self-insured, self-administered plan should not be a contributing entity, but in order to avoid disruption to contributing entities, we proposed to retain the prior definition of contributing entity for the 2014 benefit year.” Final Rule, 79 Fed. Reg. 13744, 13773 (Mar. 11, 2014).

Both definitions were captured in the promulgated regulation . Final Rule, 79 Fed. Reg. 13744, 13834 (Mar. 11, 2014) (codified at 45 C.F.R. § 153.20). The regulation provided that a “contributing entity” means that for the 2014 benefit year, a self-insured group health plan whether or not it uses a third party administrator; and for the 2015 and 2016 benefit years, a self-insured group health plan that uses a third party administrator. Id. In other words, the definition required group health plans that were both self-insured and self-administered to make contributions for 2014 but not for 2015 and 2016. 4

4 The regulation provides: For the 2014 benefit year, a self-insured group health plan (including a group health plan that is partially self-insured and partially insured, where the health insurance coverage does not constitute major medical coverage), whether or not it uses a third party administrator; and for the 2015 and 2016 benefit years, a self-insured group health plan (including a group health plan that is partially self- insured and partially insured, where the health insurance coverage does not constitute major medical coverage) that uses a third party administrator in 6 BLUE CROSS AND BLUE SHIELD OF KANSAS CITY WELFARE v. US

Free access — add to your briefcase to read the full text and ask questions with AI

Blue Cross and Blue Shield of Kansas City Welfare v. United States, (Fed. Cir. 2026).

Blue Cross and Blue Shield of Kansas City Welfare v. United States (Blue Cross and Blue Shield of Kansas City Welfare v. United States) — published by Counsel Stack Legal Research, free access to 12M+ legal documents.

Related

American Pipe & Construction Co. v. Utah
414 U.S. 538 (Supreme Court, 1974)
Crown, Cork & Seal Co. v. Parker
462 U.S. 345 (Supreme Court, 1983)
Ingrum v. United States
560 F.3d 1311 (Federal Circuit, 2009)
China Agritech, Inc. v. Resh
584 U.S. 732 (Supreme Court, 2018)
Walby v. United States
957 F.3d 1295 (Federal Circuit, 2020)
John R. Sand & Gravel Co. v. United States
552 U.S. 130 (Supreme Court, 2008)