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This Insurer Is Suing the Government Over Missing ACA Payments

May 18, 2016

Highmark Inc, the insurance arm of Pittsburgh-based non-profit Highmark Health, is suing the federal government for allegedly not meeting its obligations under the Affordable Care Act, according to The Wall Street Journal.

It's the third high-profile piece of news related to the ACA in the last couple of weeks, after a federal court ruled that the Obama administration overstepped its authority in making certain payments under the law without explicit appropriations from Congress. In another setback, the Supreme Court refused on Monday to validate the ACA's provisions regarding the coverage of contraception by employers (which are being disputed by certain Catholic organisations).

Highmark says it's owed $223 million under an ACA program known as ‘risk corridors', which aims to limit the financial risks carried by insurers under the new system. Highmark lost some $85 million last year, largely due to losses on is ACA-plan business, according to The Wall Street Journal.

This was mainly because the federal Department of Health and Human Services announced last fall that insurers initially would receive only 12.6% of the money they claimed under the risk-corridor program for 2014, its first year of operation. Highmark is seeking the full amount it says is due. Overall, insurers requested $2.87 billion in risk-corridor payments for 2014, according to the WSJ.

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