Insurers Entitled to Billions in Risk Corridors Payments, SCOTUS Says

April 30, 2020

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Source: Beckers Healthcare, by Morgan Haefner

The federal government owes health insurers $12 billion in payments from the ACA’s risk corridors program, the U.S. Supreme Court ruled April 27, according to Politico.

The temporary risk corridors program was designed to level the financial playing field for payers during the first three years of the ACA’s implementation, 2014-16. Under the program, the government collected payments from insurers with lower than expected claims on the health insurance exchanges and made payments to insurers with higher than expected claims.

However, the program faced a $12 billion shortfall, and many insurers didn’t receive payment they said they were promised. The insurers alleged the government committed a “bait and switch” on insurers.

In a 43-page opinion, SCOTUS sided with insurers. The court agreed that congressional spending restrictions don’t mean the government is exempt from funding the risk corridors program.


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