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DC Cir: No Link Between ACA 'Transition' Program and Health Insurance Premiums

By Jonathan R. Tung, Esq. on May 18, 2016 | Last updated on March 21, 2019

A lawyer for the evangelical group American Freedom Law Center has lost his Obamacare suit in the D.C. Circuit on the grounds of lack of standing.

The appellate court ruled that the AFLCA and Robert Muise, it's co-founder and senior counsel, failed to prove beyond the standard of probability that the Health and Human Service's "transitional" program (allowing non-compliant health plans to continue temporarily) actually caused a jump in his health care premiums.

Attack on Obamacare

"Obamacare," has generated its fair share of controversy over the years -- and that controversy shows no sign of slowing.

One of many challenges to the ACA, the AFLC's suit claimed that the government's transitional policy caused Muise's health insurance premiums to spike.

Muise and his institution contend that Muise's health care insurance premiums soared 57 percent by 2014 and that provisions of the government's transitional policy and actions of the DHHS were to blame.

The gravamen of Muise's argument went like this: specific programs implemented with the unfolding of the ACA were directly linked to Muise's insurance premium hikes. In 2013, two programs were implemented: the "transitional program" and the "hardship exemption", which allowed providers to temporarily continue to provide non-ACA compliant plans and allowed for some individuals to avoid penalties, respectively. The dual implementation of these programs by the ACA were the causes of Muise's insurance hike because persons like him would have to make up the shortfall -- in a word, subsidizing national health insurance.

Muise had a health insurance plan with Blue Cross that was converted into an ACA-compliant plan. Under the transitional program, Blue Cross could have continued offering Muise's original plan for a limited period -- but it chose not to. Muise's insurance premiums increased from just under $1,350 to $2,122.

Justifications Fall Short

To buttress his theory, Muise pointed out a rate filing by Blue Cross that blamed the rate hike partly on a smaller than expected pool of ACA-compliant insurers. But even though Blue Cross called this a "primary motivating factor," the circuit found the link between the rate hikes and the HHS programs to be too indirect and attenuated to form a direct causal link. And without a probable allegation of causation, standing to sue also crumbles.

We would hazard that given another court, the presiding jurists could find that enough of a causal link could be found to meet a Twombly standard. Nonetheless, the ruling marks a significant victory for ACA proponents and places health care recipients in a rough spot.

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