King v. Sebelius

997 F. Supp. 2d 415, 84 A.L.R. Fed. 2d 665, 113 A.F.T.R.2d (RIA) 961, 2014 U.S. Dist. LEXIS 20019, 2014 WL 637365
CourtDistrict Court, E.D. Virginia
DecidedFebruary 18, 2014
DocketCivil Action No. 3:13-CV-630
StatusPublished
Cited by5 cases

This text of 997 F. Supp. 2d 415 (King v. Sebelius) is published on Counsel Stack Legal Research, covering District Court, E.D. Virginia primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
King v. Sebelius, 997 F. Supp. 2d 415, 84 A.L.R. Fed. 2d 665, 113 A.F.T.R.2d (RIA) 961, 2014 U.S. Dist. LEXIS 20019, 2014 WL 637365 (E.D. Va. 2014).

Opinion

MEMORANDUM OPINION

JAMES R. SPENCER, District Judge.

THIS MATTER is before the Court on a Motion for Summary Judgment filed by Plaintiffs (ECF No. 5) and a Motion to Dismiss filed by Defendants (ECF No. 30). Plaintiffs move the Court for Summary Judgment alleging that a regulation promulgated by the Internal Revenue Service (“IRS”), which extends eligibility for premium assistance subsidies1 under the Patient Protection and Affordable Care Act (“ACA” or “Act”) to individuals who purchase health coverage through federally-facilitated Exchanges, exceeds the IRS’s statutory authority, is arbitrary and capricious, and is contrary to law in violation of the Administrative Procedure Act (“APA”), 5 U.S.C. § 706. Defendants in turn move the Court to dismiss Plaintiffs’ Complaint and uphold the relevant regulation. For the reasons below, the Court will GRANT Defendants’ Motion to Dismiss and DENY AS MOOT all remaining Motions.

I. STATUTORY AND FACTUAL BACKGROUND

A. Statutory Background

The ACA includes a series of measures intended to expand the availability of affordable health insurance coverage. These measures include: (1) the creation of health insurance exchanges (“Exchanges”) that facilitate the purchase of insurance by individuals and small groups; (2) the availability of premium tax credits to assist individuals with the purchase of insurance on the Exchanges; and (3) the Minimum Coverage Provision, which requires most individuals either to maintain qualifying coverage or to pay a tax penalty for failure to do so. The IRS has also promulgated a regulation (“IRS Rule”) that grants premium tax credits to individuals in all Exchanges, regardless of whether they are state-run or federally-facilitated.

1. The American Health Benefit Exchange System

The ACA creates health insurance Exchanges, organized along state lines, to serve as a marketplace for the purchase of health insurance by individuals and small businesses. See 42 U.S.C. § 18031(b)(1). The Exchanges are intended to help qualified individuals and small businesses “to benefit from the pooling of risk, market leverage, and economies of scale that large businesses currently enjoy.” Centers for Medicare & Medicaid Services, Initial [419]*419Guidance to States on Exchanges, http:// www.hhs.gov/cciio/resources/files/ guidance_to_states_on_exchanges.html (last visited Feb. 3, 2014). In part, the Exchanges: (1) certify the qualified health plans offered on the Exchanges; (2) determine the eligibility of individuals to enroll in these qualified health plans; (3) determine the eligibility of individuals for advance payments of the ACA’s premium tax credits and cost-sharing reductions; and (4) certify that individuals are exempt from the penalty under the Act’s Minimum Coverage Provision. 42 U.S.C. §§ 18021(a)(1), 18022; 42 U.S.C. § 18031(d)(4); see generally 45 C.F.R. § 155.200.

Exchanges will offer plans providing different levels of coverage, designated as “bronze,” “silver,” “gold,” and “platinum” coverage. 42 U.S.C. § 18022(d). A bronze level plan is the lowest level of coverage offered under 42 U.S.C. § 18022(d)(1). Exchanges may also offer “catastrophic” coverage plans. 42 U.S.C. § 18022(e); see 45 C.F.R. § 156.155. Enrollment in catastrophic coverage is limited to persons who are under 30 years of age, or for whom an Exchange has certified to be exempt from the Minimum Coverage Provision due to hardship or the lack of affordable insurance options. 42 U.S.C. § 18022(e); 45 C.F.R. § 156.155(a).

States may establish and operate these Exchange pursuant to 42 U.S.C. § 18031 (“Section 1311”), or the federal government may establish and operate an Exchange in place of the state where a state has chosen not to do so consistent with federal standards pursuant to 42 U.S.C. § 18041 (“Section 1321”). Thirty-four states, including Virginia, have decided not to establish their own Exchanges pursuant to Section 1311. See State Decisions for Creating Health Insurance Marketplaces, Kaiser State Health Facts, http://kff.org/ health-reform/state-indicator/health-xinsuranceExchanges/ (last visited Feb. 3, 2014).

2. Premium Tax Credits

Among other incentives, the ACA provides premium tax credits under 26 U.S.C. § 36B (“section 36B”) to help low and middle income individuals afford the cost of insurance purchased through the Exchanges. The Exchanges provide advance payments of premium tax credits directly to an eligible individual’s insurer, thus lowering the net cost of insurance to the individual. 42 U.S.C. §§ 18081-18082. The amount of premium assistance that an Exchange may provide for an eligible individual is based, in part, on the premium expenses for the health plan “enrolled in [by the individual] through an Exchange established by the State under [section] 1311.” 26 U.S.C. § 36B(b)(2)(A). The amount of the premium tax credit available to a taxpayer under section 36B varies depending on the taxpayer’s household income. However, premium tax credits are not available for the purchase of catastrophic coverage. 26 U.S.C. § 36B(c)(3)(A).

3. The Minimum Coverage Provision and Exemptions

Under the ACA’s Minimum Coverage Provision, non-exempt individuals are required either to maintain a minimum level of health insurance or to pay a tax penalty. 26 U.S.C. § 5000A. This penalty in 2014 is one percent of an individual’s yearly income or $95 for the year, whichever is higher, 26 U.S.C. § 5000A

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997 F. Supp. 2d 415, 84 A.L.R. Fed. 2d 665, 113 A.F.T.R.2d (RIA) 961, 2014 U.S. Dist. LEXIS 20019, 2014 WL 637365, Counsel Stack Legal Research, https://law.counselstack.com/opinion/king-v-sebelius-vaed-2014.