Why the Biden Administration Was Right Earlier This Week to Change Course in the Obamacare Challenge Pending Before the Court

VIKRAM DAVID AMAR

Illinois Law Dean Vikram David Amar comments on an unusual move by the U.S. Solicitor General’s office, sending a letter to the U.S. Supreme Court amending the position of the federal government in a case currently pending before the Court challenging the Affordable Care Act. Dean Amar explains why the arrival of a new administration should generally not trigger such position reversals, but he argues that the unusual circumstances—specifically the “exceptional implausibility” of the government’s prior filings—may justify the government’s action in this instance.

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Smith v. Allbaugh

Court: US Court of Appeals for the Tenth Circuit

Docket: 20-6029

Opinion Date: February 10, 2021

Judge: Paul Joseph Kelly, Jr.

Areas of Law: Civil Procedure, Government & Administrative Law, Health Law, Personal Injury

Plaintiff-appellee Christina Smith was the mother of Joshua England. Her claims arose from the death of England from a ruptured appendix in May 2018, while England was housed at the Joseph Harp Correctional Center (JHCC), an Oklahoma Department of Corrections (ODOC) facility in Lexington, Oklahoma. England was a 21-year-old prisoner at JHCC who was a few months away from release when he submitted multiple sick call requests. At the fifth such request, England complained his stomach hurt and he was short of breath. Unable to bear the pain while waiting at the clinic, England died in his cell from a ruptured appendix with acute peritonitis. Defendants-Appellants Joe Allbaugh, the Director of the Department of Corrections at the time this claim arose, and Carl Bear, the Warden of Joseph Harp Correctional Center (collectively, Defendants) appealed the district court’s order denying their motion to dismiss Smith's subsequent lawsuit relating to England's death on grounds of qualified immunity. The Tenth Circuit reversed, finding Smith alleged only that JHCC medical staff failed to follow procedure, not that Defendants failed to enforce those policies. Furthermore, the Court determined Smith failed to plead sufficient factual allegations to support deliberate indifference on the part of these defendants. Likewise, Smith failed to sufficiently plead Defendants improperly hired, supervised, and retained certain medical staff employees.

Fresno Community Hospital and Medical Center v. Cochran

Court: US Court of Appeals for the District of Columbia Circuit

Docket: 19-5254

Opinion Date: February 9, 2021

Judge: Arthur Raymond Randolph

Areas of Law: Civil Procedure, Health Law, Public Benefits

When Medicare overpays hospitals, it offsets that mistake by reducing future payments. By 2013, Medicare was out $11 billion because of new diagnostic codes and bookkeeping that did not keep up. Congress required that the Secretary of Health and Human Services recoup that amount by the end of fiscal year 2017 by reducing the base rate (standardized amount) paid for inpatient care and directed the Secretary to adjust the base rate by 0.5% each year through 2023, 129 Stat. 87, 163 (2015). Subsequently, while reviewing the 2017 budget, the Secretary realized that a -3.2% adjustment would leave the agency short of its $11 billion goal and announced a -3.9% adjustment. Congress then told the Secretary to increase the base rate by 0.4588% (not 0.5%) in 2018, 130 Stat. 1033, 1320 (2016). In 2017, the Secretary adjusted the base rate -3.9%. The agency met its goal. In 2018, the Secretary adjusted the base rate -3.4412%. Medicare providers sued, arguing that the Secretary should have reversed that expedient at the end of 2017 rather than carry it over into 2018, costing the hospitals $840 million in lost payments. The D.C. Circuit affirmed the dismissal of the suit. While the hospitals felt a “significant financial impact” from the -0.7% adjustment, Section 7(b)(5) bars judicial review of adjustments made under the Act.

Waupaca County v. K.E.K.

Court: Wisconsin Supreme Court

Docket: 2018AP001887

Opinion Date: February 9, 2021

Judge: Annette Kingsland Ziegler

Areas of Law: Health Law

The Supreme Court affirmed the circuit court's order extending K.E.K.'s involuntary commitment pursuant to Wis. Stat. 51.20(13)(g)3., holding that Wis. Stat. 51.20(1)(am), the statute upon which Waupaca County relied on to prove K.E.K.'s dangerous, is facially constitutional and that K.E.K.'s as-applied constitutional challenges failed. K.E.K. challenged the commitment extension on appeal, arguing that section 51.20(1)(am) was both facially unconstitutional and unconstitutional as applied because it does not require a sufficient showing of current dangerousness, as exhibited by recent acts of dangerousness. The court of appeals denied relief. The Supreme Court affirmed, holding that the statute is facially constitutional and that K.E.K.'s as-applied constitutional challenges, which the Court noted were disguised sufficiency of the evidence challenges, also failed.