Kirby Vining v. Executive Bd. of the DC Health Benefit Exchange Auth.

CourtDistrict of Columbia Court of Appeals
DecidedDecember 7, 2017
Docket15-CV-242
StatusPublished

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Opinion

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DISTRICT OF COLUMBIA COURT OF APPEALS

No. 15-CV-242

KIRBY VINING, APPELLANT,

V.

EXECUTIVE BOARD OF THE DISTRICT OF COLUMBIA HEALTH BENEFIT EXCHANGE AUTHORITY, ET AL., APPELLEES.

Appeal from the Superior Court of the District of Columbia (CAB-6496-14)

(Hon. Herbert B. Dixon, Jr., Trial Judge)

(Argued March 2, 2016 Decided December 7, 2017)

Michael Bekesha for appellant.

Jason Lederstein, Assistant Attorney General, with whom Karl A. Racine, Attorney General for the District of Columbia, Todd S. Kim, Solicitor General at the time the brief was filed, and Loren AliKhan, Deputy Solicitor General, were on the brief, for appellees.

Before GLICKMAN and EASTERLY, Associate Judges, and REID, Senior Judge.

GLICKMAN, Associate Judge: Kirby Vining appeals the dismissal of his

taxpayer suit against the District of Columbia Health Benefit Exchange Authority

and its Executive Director and Executive Board (collectively, the “Exchange 2

Authority”). Mr. Vining seeks declaratory and injunctive relief to stop what he

claims is the Exchange Authority‟s illegal use of municipal funds to allow

members of Congress, congressional employees, and their dependents to purchase

health insurance on the small business exchange created by the District under the

Patient Protection and Affordable Care Act. The Superior Court granted the

District‟s motion to dismiss the complaint pursuant to Civil Rules 12 (b)(1) for

lack of standing and 12 (b)(6) for failure to state a claim.1

We affirm the dismissal because Mr. Vining‟s status as a municipal taxpayer

does not provide him with the standing necessary to maintain this action. We

therefore do not reach the merits of Mr. Vining‟s claim of illegality, which turns on

whether federal law preempts otherwise applicable District law.

I.

As enacted by Congress in 2010, the Patient Protection and Affordable Care

Act (the “ACA”)2 envisioned that the States and the District of Columbia3 would

1 See Super. Ct. Civ. R. 12 (b)(1), (b)(6). 2 Pub. L. No. 111-148, 124 Stat. 119 (2010), codified in large part at 42 U.S.C. § 18001 et seq., as amended by the Health Care and Education Reconciliation Act of 2010, Pub. L. No. 111-152, 124 Stat. 1029 (2010). 3

establish two marketplaces for the purchase of health insurance: an “American

Health Benefit Exchange” for qualifying individual consumers and a “Small

Business Health Option Program,” or “SHOP Exchange,” for small employers

seeking group coverage for their employees.4 The ACA defines a “small

employer” eligible to use a SHOP Exchange as one with no more than one hundred

employees, though it permits States to restrict access to employers with no more

than fifty employees.5

In 2012, the Council of the District of Columbia created the Exchange

Authority as an independent agency and directed it to establish the individual and

small business exchanges necessary to implement the ACA.6 The Exchange

Authority Act defines a “small employer” eligible to participate in a District SHOP

Exchange as one employing on average no more than fifty employees. 7 The

(…continued) 3 The ACA includes the District of Columbia in its definition of “State.” See ACA § 1304 (d). 4 Id. § 1311 (b). 5 Id. §§ 1304 (b)(2), (b)(3). 6 See D.C. Code § 31-3171.01 et seq. (2012 Repl. & 2017 Cum. Supp.). 7 Id. § 31-3171.01 (16)(A). 4

Council established a “nonlapsing” fund (the “Exchange Fund”) exclusively for the

Exchange Authority to draw on in order to carry out its responsibilities.8

The ACA also provided that after January 1, 2014, the Federal Government

could make health insurance plans available to Members of Congress and

congressional staff only through a State exchange.9 In response to this provision,

OPM issued final regulations in October 2013 requiring the Members and staff of

Congress to enroll in a plan offered on the District of Columbia SHOP Exchange

in order to receive federal contributions to their insurance premiums. 10 The

Centers for Medicare and Medicaid Services in the Department of Health and

Human Services issued interpretive guidance stating that size requirements for

8 See D.C. Code § 3171.03. Monies deposited into the Exchange Fund, and interest earned thereon, “shall not revert to the unrestricted fund balance of the General Fund of the District of Columbia at the end of a fiscal year, or at any other time, but shall be continually available for the uses and purposes [of the Exchange Authority] without regard to fiscal year limitation, subject to authorization by Congress.” Id. § 3171.03 (c). 9 ACA § 1312 (d)(3)(D). Before this requirement took effect, the Federal Government provided health benefits to Members of Congress and congressional staff the same way it provided them to other federal employees, i.e., through the Federal Employee Health Benefits Act, 5 U.S.C. § 8901 et seq., as administered by the Office of Personnel Management (“OPM”), id. § 8913. 10 Federal Employees Health Benefits Program: Members of Congress and Congressional Staff, 78 Fed. Reg. 60653, 60654-56 (Oct. 2, 2013) (codified at 5 C.F.R. § 890 et seq. (2015)). 5

small employers to participate in SHOP Exchanges would not apply to Members of

Congress and congressional staff.11

Mr. Vining sued the Exchange Authority in October 2014. His complaint

alleged that since November 2013, the Exchange Authority had allowed at least

12,359 congressional employees and dependents to purchase health insurance on

the District of Columbia SHOP Exchange, in contravention of the provision in the

District‟s Exchange Authority Act restricting participation in the small business

exchange to employers with fifty or fewer employees.12 Mr. Vining further alleged

that this “illegal” operation of the District‟s SHOP Exchange caused irreparable

injury to his “interests as a taxpayer” because the Exchange Fund used to

administer the Exchange included taxpayer money appropriated annually by the

Council from the District‟s General Fund. The complaint requested the court to

grant equitable relief, including a declaration that congressional participation in the

District‟s SHOP Exchange was unlawful and an injunction barring the Exchange

11 Centers for Medicare and Medicaid Services, Affordable Insurance Exchanges Guidance: Members of Congress and Staff Accessing Coverage Through Health Insurance Exchanges (Marketplaces) (2013), https://perma.cc/XGZ3-C8VT. 12 See supra note 7. The complaint alleged that the 12,359 congressional employees and dependents represented approximately 86% of the total number of persons enrolled in the SHOP Exchange. 6

Authority from allowing such participation “or, at a minimum, from expending

further taxpayer funds” thereon.

In moving to dismiss the complaint pursuant to Civil Rule 12 (b)(1) on

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