Cutler v. United States Department of Health & Human Services

797 F.3d 1173, 418 U.S. App. D.C. 309, 2015 U.S. App. LEXIS 14268, 2015 WL 4772705
CourtCourt of Appeals for the D.C. Circuit
DecidedAugust 14, 2015
Docket14-5183
StatusPublished
Cited by19 cases

This text of 797 F.3d 1173 (Cutler v. United States Department of Health & Human Services) is published on Counsel Stack Legal Research, covering Court of Appeals for the D.C. Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Cutler v. United States Department of Health & Human Services, 797 F.3d 1173, 418 U.S. App. D.C. 309, 2015 U.S. App. LEXIS 14268, 2015 WL 4772705 (D.C. Cir. 2015).

Opinion

Opinion for the Court filed by Circuit Judge MILLETT. ■

MILLETT, Circuit Judge:

Jeffrey Cutler’s insurance company can-celled his health insurance plan because it did not comply with the requirements of the Patient Protection and Affordable Care Act (“Affordable Care Act” or “Act”), Pub.L. No. 111-148, 124 Stat. 119 (2010). He objects to the requirement that he buy compliant insurance for personal, but not religious, reasons. So he filed suit chal: lenging the religious exemption in the Affordable ' Care Act as an unconstitutional establishment of religion. He also argues that the Administration’s decision to temporarily ■ suspend enforcement of some of the Act’s requirements for a transitional period deprived him of the equal protection of the laws. While we disagree with the district court’s holding that he lacked standing to press his Establishment Clause challenge, long-settled precedent dooms his claim on the merits. Cutler lacks standing to assert his equal protection claim because nothing in the transitional policy requires him to buy insurance; his inability to maintain his old plan was the independent choice of his insurer.

I

Statutory and Regulatory Framework

Congress enacted the Affordable Care Act in 2010 in an effort to “increase the number of Americans covered by health insurance and decrease the cost of health care.” National Federation of Independent Business v. Sebelius, — U.S. -, 132 S.Ct. 2566, 2580, 183 L.Ed.2d 450 (2012). Key to the Act’s “interlocking reforms,” King v. Burwell, 576 U.S. -, 135 S.Ct. 2480, 2485, 192 L.Ed.2d 483 (2015), is a general requirement that individuals must maintain health insurance coverage or pay a tax penalty to the Internal Revenue Service. 26 U.S.C. § 5000A. Without that obligation to obtain insurance, Congress found, “many individuals would wait to purchase health insurance until they needed care,” 42 U.S.C. § 18091(2)(I), creating an “adverse selection * * * death spiral” that would destabilize insurance markets, King, 135 S.Ct. *1176 at 2485-86. 1 Consistent with the statutory-goals of near-universal coverage and protecting the efficient functioning of the health insurance market, 42 U.S.C. § 18091(2)(D) and (I), Congress allowed only carefully limited exceptions to the general obligation to maintain health insurance. See Seven-Sky v. Holder, 661 F.3d 1, 6 (D.C.Cir,2011). Of relevance here, the Affordable Care Act generally exempts those with sincere religious objections to purchasing health insurance. See 26 U.S.C. § 5000A(d)(2). Specifically, the Act provides for a “religious conscience exemption” that applies to an individual who is both “(i) a member of a recognized religious sect or division thereof which is described in [26 U.S.C.] section 1402(g)(1),” and “(ii) an adherent of established tenets or teachings of such sect or division as described in such section.” 26 U.S.C. § 5000A(d)(2)(A)(i)-(ii).

Section 1402(g)(1) of Title 26, in turn, houses the religious exemption from Social Security and Medicare taxes, which Congress enacted as part of the Social Security Amendments of 1965, Pub.L. No. 89-97, 79 Stat. 286. That provision allows an individual who, because of religious faith, is “conscientiously opposed to acceptance of the benefits of any private or public [health] insurance,” to opt out of the Social Security and Medicare programs. 26 U.S.C. § 1402(g)(1). 2

To qualify for the exemption, an individual must prove “membership in, and adherence to the tenets or teachings of, the sect or division thereof’ and must waive “all benefits and other payments” under the Social Security and Medicare programs. 26 U.S.C. § 1402(g)(l)(A)-(B). In addition, the Commissioner of Social Secúrity must find that (i) the “sect or division thereof has the [relevant] established tenets or teachings[,]” (ii) “it is the practice * * * for members of such sect or division thereof to make provision for their dependent members,” and (iii) “such sect or division thereof has been in existence at all times since December 31, 1950.” Id. § 1402(g)(l)(C)-(E). 3

*1177 The Affordable Care Act religious exemption thus comes as a package deal with the Medicare and Social Security religious exemption. The qualifications for each include not only sincere religious belief, but also membership in a group with an established track record of providing care for its members in need and thus ensuring that the cost of their care is not transferred to the public.

Aside from the coverage requirement for individuals, the Affordable Care Act imposes a number of requirements on insurance providers and employers who offer health insurance to their workers, such as the guaranteed availability of coverage and a prohibition on refusing coverage due to an applicant’s pre-existing medical condition. See 42 U.S.C. § 300gg-l. The Centers for Medicare and Medicaid Services (“the Centers”), which is part of the Department of Health and Human Services, oversees the implementation of many of the legislatively mandated changes.

Several of the Affordable Care Act’s new requirements were scheduled to take effect on January 1, 2014, including provisions governing insurance premiums and discrimination on the basis of preexisting conditions. See 42 U.S.C. § 300gg (relating to fair health insurance premiums); id. § 300gg-l (relating to guaranteed availability of coverage and ban on pre-existing condition requirements); id. § 300gg (note) (effective date). But the Centers determined that many “affected individuals and small businesses * * * [were] finding that [Affordable Care Act-compliant] coverage would be more expensive than their current coverage, and thus they may be dissuaded from immediately transitioning to such coverage.” Letter from Gary Cohen, Director, Center for Consumer Information and Insurance Oversight, Centers for Medicare and Medicaid Services, to State Insurance Commissioners, Nov. 14, 2013, at l. 4

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Cite This Page — Counsel Stack

Bluebook (online)
797 F.3d 1173, 418 U.S. App. D.C. 309, 2015 U.S. App. LEXIS 14268, 2015 WL 4772705, Counsel Stack Legal Research, https://law.counselstack.com/opinion/cutler-v-united-states-department-of-health-human-services-cadc-2015.