St. Louis Effort for Aids v. Huff

996 F. Supp. 2d 798, 2014 WL 273201, 2014 U.S. Dist. LEXIS 8187
CourtDistrict Court, W.D. Missouri
DecidedJanuary 23, 2014
DocketCase No. 13-4246-CV-C-ODS
StatusPublished
Cited by2 cases

This text of 996 F. Supp. 2d 798 (St. Louis Effort for Aids v. Huff) is published on Counsel Stack Legal Research, covering District Court, W.D. Missouri primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
St. Louis Effort for Aids v. Huff, 996 F. Supp. 2d 798, 2014 WL 273201, 2014 U.S. Dist. LEXIS 8187 (W.D. Mo. 2014).

Opinion

ORDER AND OPINION'(1) GRANTING IN PART PLAINTIFFS’ MOTION FOR PRELIMINARY INJUNCTION, (2) DENYING DEFENDANT’S MOTION TO DISMISS, AND (3) DENYING PARTIES’ REQUESTS FOR ORAL ARGUMENT,

ORTRIE D. SMITH, Senior District Judge.

Pending is Plaintiffs’ Motion for Preliminary Injunction, which seeks to enjoin Defendant (the Director of the Missouri Department of Insurance, Financial Institutions and Professional Registration) from enforcing various provisions of Missouri’s Health Insurance Marketplace Innovation Act (“HIMIA”). The Court concludes an injunction is justified to enjoin enforcement of HIMIA insofar as it applies to entities and individuals certified under federal law to provide services or perform functions pursuant to the Affordable Care Act and its attendant regulations. Such entities and individuals specifically include Counselor Designated Organizations, Navigators, and Certified Application Counselors (collectively “Federal Counselors”). The Court reaches this conclusion without holding a hearing or entertaining oral argument because (1) the issues to be resolved are legal and not factual, (2) neither side has suggested there are relevant factual issues to be resolved, and (3) the parties’ filings have sufficiently addressed the legal issues.

I. BACKGROUND

“In 2010, Congress enacted the Patient Protection and Affordable Care Act, 124 [801]*801Stat. 119 [ (the ‘ACA’) ]. The Act aims 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); see also 42 U.S.C. § 18091. Individuals who cannot obtain qualified health plans (“QHPs”) from their employer, including “part-time employees, self-employed individuals, and unemployed individuals are steered to the insurance exchanges established under the ACA, where the government offers subsidies to those who cannot shoulder the full cost of insurance on their own.” Korte v. Sebelius, 735 F.3d 654, 728 (7th Cir.2013). As part of providing QHPs, the exchanges provide the opportunity for individuals and employers to compare various health plans.

The ACA provides a mechanism for states to establish these exchanges, e.g., 42 U.S.C. § 18031(b), but in those states that chose not to do so the Secretary of Health and Human Services (“HHS”) is responsible for establishing and operating the exchange. E.g., 42 U.S.C. § 18041(c)(1); 78 Fed.Reg. 42824. The federal exchange is often referred to as a “Federally Facilitated Exchange” or “FFE.” HHS must contract with appropriate not-for-profit entities in the state to operate the FFE. 42 U.S.C. § 18041(c)(1).

All exchanges — whether they are FFEs or created by the state — share certain requirements. Obviously, in the case of an FFE it is the federal government— through HHS — that is responsible for meeting those requirements. Included in the requirements is the creation of a Certified Application Assistance Program consisting of some combination of (1) Certified Application Counselors (“CACs”) and (2) Navigators. The duties of CACs and Navigators are spelled out in the ACA, and are further refined in HHS regulations. Those regulations also regulate the conduct of CACs and Navigators. For instance, exchanges are required to create a “certified application counselor program” by either designating organizations to certify counselors or directly certifying members or individuals of other organizations. 45 C.F.R. §§ 155.225(a), 155.225(b)(2). Standards for certification and the counselors’ obligations are further specified in the regulation. Id. § 155.225(d). The Exchange is responsible for overseeing counselors and must create a procedure for withdrawing certification if it finds a counselor has violated the regulations. Id. § 155.225(e). Similarly, an exchange “must establish a [Federal] Navigator program ... through which it awards grants to eligible public or private entities or individuals” as described in applicable regulations. 45 C.F.R. § 155.210(a). In the course of doing so, the exchange must establish standards and a course of training for Navigators. Id. § 155.210(b); see also 42 U.S.C. § 18031(i)(4). Thus, those entities and individuals previously defined in this Order as Federal Counselors— Counselor Designated Organizations, Navigators, and Certified Application Counselors — are all certified, approved, and subject to oversight by HHS either directly or indirectly.

Plaintiffs St. Louis Effort for Aids and Planned Parenthood of the St. Louis Region and Southwest Missouri (the “CAC Plaintiffs”) are Counselor Designated Organizations, CACs, and Navigators under the ACA; they also employ individuals who are certified as CACs and Navigators. It also appears the CAC Plaintiffs are tasked with training Navigators. E.g., Complaint, ¶¶ 7-8; Plaintiffs’ Exhibit 1 at ¶¶ 4, 6; Plaintiffs’ Exhibit 2 at ¶¶ 4, 6. Plaintiffs’ Suggestions at 2, 14. The remaining Plaintiffs are: Consumers Council of Missouri, Missouri Jobs with Justice, Jeanette Oxford, Dr. Wayne Letizia, Dr. [802]*802William Fogarty, and Chris Worth. These individuals and entities are not described as CACs, Navigators, or any other Federal Counselor certified under the ACA.

The State of Missouri opted not to create an exchange, so HHS created and operates the FFE in Missouri. Missouri subsequently passed the Health Insurance Marketplace Innovation Act of 2013 (“HI-MIA”), which regulates the conduct of those performing duties on behalf of the FFE. All Plaintiffs seek to enjoin certain provisions of HIMIA, arguing the provisions (1) are preempted and violate the Supremacy Clause, (2) violate the First Amendment, and (3) violate the Due Process Clause. Defendant filed a motion to dismiss, contending that his arguments against the preliminary injunction demonstrate Plaintiffs have failed to state a cause of action for which relief can be granted. The Court will focus on the preemption/Supremacy Clause issues because they are dispositive of the issues raised in the motions.

II. DISCUSSION

A Standards

1. Preliminary Injunctions

“A preliminary injunction is an extraordinary remedy and the burden of establishing the propriety of an injunction is on the movant.” Watkins Inc. v. Lewis, 346 F.3d 841, 844 (8th Cir.2003) (internal citation omitted).

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Bluebook (online)
996 F. Supp. 2d 798, 2014 WL 273201, 2014 U.S. Dist. LEXIS 8187, Counsel Stack Legal Research, https://law.counselstack.com/opinion/st-louis-effort-for-aids-v-huff-mowd-2014.