Conway v. United States

997 F.3d 1198
CourtCourt of Appeals for the Federal Circuit
DecidedMay 17, 2021
Docket20-1292
StatusPublished
Cited by5 cases

This text of 997 F.3d 1198 (Conway v. United States) is published on Counsel Stack Legal Research, covering Court of Appeals for the Federal Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Conway v. United States, 997 F.3d 1198 (Fed. Cir. 2021).

Opinion

Case: 20-1292 Document: 48 Page: 1 Filed: 05/17/2021

United States Court of Appeals for the Federal Circuit ______________________

MICHAEL CONWAY, IN HIS CAPACITY AS LIQUIDATOR OF COLORADO HEALTH INSURANCE COOPERATIVE, INC., Plaintiff-Appellee

v.

UNITED STATES, Defendant-Appellant ______________________

2020-1292 ______________________

Appeal from the United States Court of Federal Claims in No. 1:18-cv-01623-RAH, Judge Richard A. Hertling. ______________________

Decided: May 17, 2021 ______________________

CLIFTON S. ELGARTEN, Crowell & Moring LLP, Wash- ington, DC, argued for plaintiff-appellee. Also represented by CHARLES BAEK, SKYE MATHIESON, STEPHEN JOHN MCBRADY, MONICA ROSE STERLING, DANIEL WILLIAM WOLFF.

ALISA BETH KLEIN, Appellate Staff, Civil Division, United States Department of Justice, Washington, DC, ar- gued for defendant-appellant. Also represented by JEFFREY B. CLARK, JEFFREY ERIC SANDBERG. ______________________ Case: 20-1292 Document: 48 Page: 2 Filed: 05/17/2021

Before MOORE, BRYSON, and CHEN, Circuit Judges. MOORE, Circuit Judge. The government appeals a final judgment of the United States Court of Federal Claims. J.A. 21; see also Conway v. United States, 145 Fed. Cl. 514 (2019) (“Claims Court Op.”). In 2016, a Colorado court ordered Colorado Health Insurance Cooperative, Inc., into liquidation. At the time, the government owed Colorado Health $24,489,799 for re- insurance debts under the Patient Protection and Afforda- ble Care Act (ACA), Pub. L. No. 111-148, 124 Stat. 119 (2010), and related regulations. Colorado Health, on the other hand, owed the Department of Health and Human Services approximately $42,000,000 for risk adjustment debts, another program under the ACA and related regula- tions. The government attempted to leapfrog other insol- vency creditors through offset, rather than paying its debt in full and making a claim against Colorado Health’s estate as an insolvency creditor. The Claims Court, however, or- dered the government to pay. For the following reasons, we affirm. BACKGROUND In the ACA, Congress adopted “a series of interlocking reforms designed to expand coverage in the individual health insurance market.” King v. Burwell, 576 U.S. 473, 478–79 (2015). As part of the ACA, Congress enacted three risk-mitigation programs, often called the “3Rs.” 42 U.S.C. §§ 18061 (reinsurance), 18062 (risk corridors), 18063 (risk adjustment). In general, the 3Rs were aimed at stabilizing health insurance premiums. Patient Protection and Af- fordable Care Act; HHS Notice of Benefit and Payment Pa- rameters for 2014, 78 Fed. Reg. 15,410, 15,411 (Mar. 11, 2013) (to be codified at 45 C.F.R. pts. 153, 155–58) (“2014 Final Rule”). Case: 20-1292 Document: 48 Page: 3 Filed: 05/17/2021

CONWAY v. UNITED STATES 3

Here, the risk adjustment and reinsurance programs are particularly relevant. The risk adjustment program, which is permanent, charges insurers of individuals who had below-average actuarial risk and pays insurers of indi- viduals who had above-average actuarial risk. 42 U.S.C. § 18063(a). It “is intended to provide increased payments to health insurance issuers that attract higher-risk popu- lations, such as those with chronic conditions, and reduce the incentives for issuers to avoid higher-risk enrollees.” 2014 Final Rule, 78 Fed. Reg. at 15,411. The reinsurance program, which only lasted three years, collected yearly payments from all insurers and made payments to insurers of particularly costly individuals that year. 42 U.S.C. § 18061. It “[wa]s designed to protect against issuers’ po- tential perceived need to raise premiums due to the imple- mentation of the 2014 market reform rules, specifically, guaranteed availability.” 2014 Final Rule, 78 Fed. Reg. at 15,467. Both programs operate on a state-by-state basis, and states are permitted to craft their own programs, pro- vided the plans comply with federal standards. 42 U.S.C. § 18041(a)–(b). If states fail to act, however, the Depart- ment of Health and Human Services (HHS) must step in. Id. § 18041(c). In all but two states, HHS operates both programs. To implement these programs, HHS has promulgated extensive regulations. See, e.g., 2014 Final Rule, 78 Fed. Reg. at 15,411–540. One such regulation, designed to ease HHS’ administration of the 3Rs, allows for netting of pay- ments: HHS may net payments owed to issuers and their affiliates operating under the same tax identifica- tion number against amounts due to the Federal or State governments from the issuers and their affili- ates under the same taxpayer identification number for . . . risk adjustment [and] reinsurance . . . pay- ments and charges. Case: 20-1292 Document: 48 Page: 4 Filed: 05/17/2021

45 C.F.R. § 156.1215(b) (the “Netting Regulation”) (appli- cable after 2014). In promulgating the Netting Regulation, HHS explained that it was designed “to streamline pay- ment and charge flows from all of these programs” and that HHS believed “this process w[ould] enable [it] to operate a monthly payment cycle that will be efficient for both issu- ers and HHS.” Patient Protection and Affordable Care Act; HHS Notice of Benefit and Payment Parameters for 2015, 79 Fed. Reg. 13,744, 13,817 (Mar. 11, 2014) (“2015 Final Rule”). The ACA also created a Consumer Operated and Ori- ented Plan (CO-OP) program “to foster the creation of qual- ified nonprofit health insurance issuers to offer qualified health plans in the individual and small group markets in the States in which the issuers are licensed to offer such plans.” 42 U.S.C. § 18042(a)(2). That program provided loans and grants to persons “applying to become qualified nonprofit health insurance issuers.” Id. § 18042(b)(1). In setting repayment terms for those loans, HHS is required to comply with state solvency law. Id. § 18042(b)(3). Colorado Health, a CO-OP program insurer, partici- pated in the Colorado reinsurance and risk-adjustment programs for benefit year 2015. Because Colorado had de- clined to administer those programs, HHS operated both. For that year, HHS owed Colorado Health $38,664,334.67 under the reinsurance program, and Colorado Health owed HHS approximately $42,000,000 under the risk-adjust- ment program. In early 2016, before the final obligations for benefit year 2015 were tabulated, HHS made an early reinsurance payment. Accounting for that payment, HHS still owes Colorado Health $24,489,799. No other pay- ments have been made. Soon after HHS’ early payment, a Colorado court or- dered Colorado Health into liquidation. Liquidation is a bankruptcy-like proceeding during which a liquidator, here Michael Conway, collects and distributes an insurer’s Case: 20-1292 Document: 48 Page: 5 Filed: 05/17/2021

CONWAY v. UNITED STATES 5

assets. In Colorado, such proceedings are governed by the Insurers’ Rehabilitation and Liquidation Act. Colo. Rev. Stat. §§ 10-3-501 to 10-3-559; see also 1992 Colo. Legis. Serv. S.B. 92–12 (repealing and recodifying that Act in its entirety). The Act sets the priority for asset distribution. See Colo. Rev. Stat. § 10-3-541. For example, it prioritizes administrative expenses and policyholders over the federal government: Class 1.

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