Iowa Individual Health Benefit Reinsurance Association v. State University of Iowa, Iowa State University of Science and Technology, and University of Northern Iowa

876 N.W.2d 800, 2016 Iowa Sup. LEXIS 34
CourtSupreme Court of Iowa
DecidedMarch 18, 2016
Docket14–1605
StatusPublished
Cited by26 cases

This text of 876 N.W.2d 800 (Iowa Individual Health Benefit Reinsurance Association v. State University of Iowa, Iowa State University of Science and Technology, and University of Northern Iowa) is published on Counsel Stack Legal Research, covering Supreme Court of Iowa primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Iowa Individual Health Benefit Reinsurance Association v. State University of Iowa, Iowa State University of Science and Technology, and University of Northern Iowa, 876 N.W.2d 800, 2016 Iowa Sup. LEXIS 34 (iowa 2016).

Opinion

WATERMAN, Justice.

In this appeal, we must determine whether a nonprofit corporation, the Iowa Individual Health Benefit Reinsurance Association (IIHBRA), has the capacity to sue its members for unpaid assessments it is statutorily obligated to collect and, if so, whether this case is subject to mandatory arbitration under Iowa Code section 679A.19 (2013). The IIHBRA was created under Iowa Code chapter 513C (1997) and incorporated under chapter 504A. 1 Chapter 513C initially included a provision list *802 ing among the IIHBRA’s powers the authority to “sue or be sued,” a power also set forth in chapter 504A. See Iowa Code § 513C.10(5)(6) (1997); id. § 504A.4(2). A 2001 amendment deleted that redundant provision from chapter 513C but left intact the IIHBRA’s duty to collect assessments. See 2001 Iowa Acts ch. 125, § 5. The IIHBRA sued several alleged members — Iowa’s regent universities — for unpaid assessments. The universities moved to dismiss, contending the 2001 amendment revoked the IIHBRA’s power to sue. Alternatively, the universities argued the district court lacked subject matter jurisdiction because the IIHBRA is an administrative department, commission, or board of the state government and is therefore required to arbitrate under Iowa Code section 679A.19 (2013). The IIH-BRA resisted, arguing it retained the capacity to sue under chapter 504 and is not subject to the arbitration statute. The district court, without deciding the arbitration issue, ruled that the 2001 amendment to chapter 513C revoked the IIH-BRA’s capacity to sue and dismissed the action. The court of appeals affirmed. We granted the IIHBRA’s application for further review.

For the reasons explained below, we hold the IIHBRA has the capacity to sue its members in district court for unpaid assessments. The 2001 amendment to chapter 513C left intact the IIHBRA’s capacity to sue under chapter 504A, and the IIHBRA is not an “administrative department, commission or board of the state government” subject to mandatory arbitration under section 679A.19. Accordingly, we vacate the decision of the court of appeals, reverse the distinct court’s dismissal order, and remand the case for further proceedings.

I. Background and Procedural History.

This appeal involves two statutes addressing access to health insurance, specifically high-risk policies for individuals with preexisting medical conditions. An overview of this legislation provides context for the issues on appeal. In 1986, the legislature enacted Iowa Code chapter 514E, which created the Iowa Comprehensive Health Insurance Association (ICHIA). See 1986 Iowa Acts ch. 1156, § 2 (codified at Iowa Code § 514E.2 (1987)). The IC-HIA issues its own individual and group health insurance policies to eligible Iowans. See Iowa Code § 514E.2 (2013). The goal of chapter 514E was to provide health insurance to Iowans unable to obtain affordable coverage on the private market. See id. The insurance commissioner determined the ICHIA program was underutilized and, in 1994, issued a bulletin reminding private health insurers of their obligation under section 514E.11 to notify applicants of the option to purchase ICHIA policies whenever the insurer rejected the applicant or offered coverage at a higher rate. Therese M. Vaughan, Iowa Ins. Div., Bulletin No. 9⅛-6 Utilization of Iowa Comprehensive Health Association’s Policy Services (1994), rescinded by Nick Gerhart, Iowa Ins. Div., Bulletin No. 13-k — Rescission of Insurance Division Bulletins 4 (2013).

In 1995, the legislature enacted Iowa Code chapter 513C, the Individual Health Insurance Market Reform Act. 1995 Iowa Acts ch. 5, §§ 3-13 (codified at Iowa Code ch. 513C (1997)). The legislature expressed the goal of this Act as follows:

The purpose and intent of this chapter is to promote the availability of health *803 insurance coverage to individuals regardless of their health status or claims experience, to prevent abusive rating practices, to require disclosure of rating practices to purchasers, to establish rules regarding the renewal of coverage, to establish limitations on the use of preexisting condition exclusions, to assure fair access to health plans, and to improve the overall fairness and efficiency of the individual health insurance market.

Iowa Co4e § 513C.2 (1997). Section 10 created the IIHBRA, a. nonprofit corporation organized under Iowa Code chapter 504A. Id. § 5130.10(1). Membership in the IIHBRA is mandatory for health insurance companies selling coverage in Iowa, as well as health maintenance organizations, fraternal societies, and self-insured employers that offer health benefit plans subject to state insurance regulation. Id. The members are required to “report the amount of earned premiums and the associated paid losses for all basic and standard plans.” Id. § 513C.10(7). The IIHBRA uses these reports to determine and collect a yearly assessment from healthcare providers to spread the cost of providing health insurance to Iowans who cannot afford to pay market rates for high-risk policies. Id. § 513C.10(10).

In 2001, the legislature amended chapters 513C and 514E to mergé the boards of directors of the IIHBRA and the ICHIA and delete from chapter 513C the enumeration of certain powers, including the power to sue. See id. § 5130.10(5); 2001 Iowa Acts ch. 125, § 5. The -amendment left-intact the IIHBRA’s duty to ascertain and collect assessments from its members. See Iowa Code § 5130.10(3) (2003). No prohibition on suits was added. Another amendment in 2003 clarified the members’ obligation to report data and pay assessments to the IIHBRA. 2003 Iowa Acts ch. 91; § 26 (codified at Iowa Code § 5130.10(6) (2005)).

The IIHBRA filed this civil action on November 1, 2013. The IIHBRA’s petition alleges that the State University of Iowa (SUI), Iowa State University of Science and Technology (ISU), and the University of Northern Iowa (UNI) (collectively, the universities) are members required to submit annual reports and pay assessments due under-Iowa Code chapter 513C. In 2010, the universities submitted their reports but failed to pay their assessments. The IIHBRA alleges the following assessments are owed for 2010: $508,030 from SUI, $198,852 from ISU, and $78,131 from UNI, plus interest and costs. In 2011, the universities failed to .submit reports or pay any assessments. The IIHBRA demands payment of the assessments, as well as in-junctive relief requiring annual reporting by the universities.

On January 17, 2014, the universities filed a preanswer motion to dismiss the petition.

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876 N.W.2d 800, 2016 Iowa Sup. LEXIS 34, Counsel Stack Legal Research, https://law.counselstack.com/opinion/iowa-individual-health-benefit-reinsurance-association-v-state-university-iowa-2016.