All eyes on the federal courts

The federal courts ruled the insurance industry and markets throughout 2019. Much of the flexibility that the Trump administration introduced in 2018 allowing health insurers and states to skirt certain Affordable Care Act rules ended up debated in court this year.

Meanwhile, the 5th U.S. Circuit Court of Appeals in July heard oral arguments in a Republican-state challenge to the ACA that threatens to eliminate coverage for millions of Americans if a lower court ruling invalidating the law is upheld. At deadline, there was still no decision.

In March, a federal court struck down the Trump administration’s rule expanding access to association health plans, which don’t have to comply with all of the ACA’s consumer protections. The administration appealed and oral arguments were held in November.

But in July another judge ruled that the administration could continue its expansion of short-term, limited-duration health plans—policies that are cheaper than ACA-compliant plans but can deny coverage for pre-existing health conditions.

Importantly, the U.S. Supreme Court Dec. 10 heard oral arguments over the ACA risk-corridors program, in which health insurers claim they are owed billions in unpaid funds.

Several insurers won challenges over the Trump administration’s abrupt cutoff of the cost-sharing reduction subsidies in 2017. A judge in October ruled the insurers involved in a class action over the subsidies are owed $1.6 billion.