DEBORAH K. CHASANOW, District Judge.
Presently pending and ready for resolution is the motion to dismiss filed by Defendants Thomas E. Price,
Plaintiff Electrical Welfare Trust Fund, Inc. ("Plaintiff") is a self-funded, self-administered group health plan. Under the Patient Protection and Affordable Care Act of 2010 ("ACA"), all individuals must maintain "minimum essential" health insurance coverage, 26 U.S.C. § 5000A, and health insurance providers cannot discriminate against individuals with pre-existing medical conditions by denying them coverage, 42 U.S.C. § 300gg-3. As a result of these policy changes, Congress anticipated that the enrollment of a disproportionate number of previously uninsured, high-risk individuals into the health insurance market could cause premiums to rise for all insured individuals. To stabilize premiums during the first three years, the ACA established the Transitional Reinsurance Program ("TRP"). See 42 U.S.C. § 18061(c)(1). The TRP mandates that all "health insurance issuers, and third party administrators on behalf of group health plans, . . . make payments to an applicable reinsurance entity for any plan beginning in the 3-year period beginning January 1, 2014." Id. § 18061(b)(1)(A). The "reinsurance entities" then reallocate the money collected to health insurance issuers that incur higher costs by covering high-risk individuals. Id. § 18061(b)(1)(B).
Under the TRP provisions, the Secretary is tasked with "issu[ing] regulations setting standards for meeting the requirements . . . with respect to . . . the establishment of the reinsurance and risk adjustment programs." 42 U.S.C. § 18041(a)(1)(C). Specifically, the Secretary has the authority to determine the methodology for setting the amounts each health insurance issuer must contribute to the reinsurance entities under the reinsurance mandate. Id. § 18061(b)(3)(A). Pursuant to this authority, the Secretary issued a regulation defining a "contributing entity" with respect to group health plans as: "a self-insured group health plan . . . whether or not it uses a third party administrator" for the 2014 benefit year; and "a self-insured group health plan . . . that uses a third party administrator" for the 2015 and 2016 benefit years. 45 C.F.R. § 153.20(2). Therefore, self-insured, self-administered group health plans were subject to the reinsurance mandate and had to contribute to the TRP for 2014, but not for 2015 and 2016. Id. In rulemaking comments, the Secretary explained this change in status for such plans by noting that the statute could "reasonably be interpreted in more than one way with respect to the applicability of [the reinsurance mandate] to self-insured, self-administered plans." Patient Protection and Affordable Care Act; HHS Notice of Benefit and Payment Parameters for 2015, 79 Fed. Reg. 13,773 (Mar. 11, 2014). The Secretary stated that the "better reading" was to exclude such entities from the reinsurance mandate, but that the government would include these entities for the 2014 year "in order to avoid disruption to contributing entities." Id.
Plaintiff is a self-funded, self-administered group health plan that was subject to, and paid, the reinsurance mandate for the 2014 benefit year. (ECF No. 1 ¶ 20). On June 17, 2016, Plaintiff filed this tax refund suit on behalf of itself and the putative class of similarly situated self-funded, self-administered health plans. (ECF No. 1). Plaintiff asserts that the Secretary's interpretation of the statute impermissibly included such plans among those required to pay reinsurance contributions for the benefit year 2014. It contends that the ACA is unambiguous with respect to which entities are required to abide by the reinsurance mandate and maintains that self-funded, self-administered group health plans are not among them. The Government moved to dismiss the case for lack of subject matter jurisdiction on November 28. (ECF No. 18). Plaintiff responded in opposition (ECF No. 19), and the Government replied (ECF No. 24).
The Government moves to dismiss for lack of subject matter jurisdiction because sovereign immunity bars Plaintiff's claims. (ECF No. 18). Generally, "questions of subject matter jurisdiction must be decided first, because they concern the court's very power to hear the case." Owens-Illinois, Inc. v. Meade, 186 F.3d 435, 442 n.4 (4
The doctrine of sovereign immunity precludes suit against the United States, "`save as it consents to be sued.'" Frahm v. United States, 492 F.3d 258, 262 (4
Plaintiff contends that the reinsurance mandate is a tax. It argues that the applicable test in the United States Court of Appeals for the Fourth Circuit comes from In re Leckie Smokeless Coal Co., 99 F.3d 573 (4
In Pittston Co. v. United States, 199 F.3d 694, 702 (4
Applying the test from Leckie, Plaintiff contends that its reinsurance contributions are a tax because they are "(a) an involuntary pecuniary burden, laid upon Plaintiff and Class members; (b) imposed by Congress; (c) for public purposes, including . . . defraying health insurance coverage expenses; (d) under the taxing power of Government." (ECF No. 19, at 21). Plaintiff also argues generally that United States Supreme Court precedent makes clear that "congressional labels have little bearing on whether an exaction qualifies as a `tax' for statutory purposes." (ECF No. 19, at 21). Instead, it posits, the "essential character" of an exaction governs whether it qualifies as a tax. (Id. at 22).
The Government argues that National Federation of Independent Business v. Sebelius, 567 U.S. 519 (2012) ("NFIB"), limits the applicability of the Leckie test here. (ECF No. 24, at 14-15). In NFIB, the Supreme Court considered, inter alia, whether the individual insurance mandate in the ACA, which was labeled a "penalty" instead of a "tax," qualified as a tax under the Anti-Injunction Act. The Court emphasized that, as "creatures of Congress's own creation," Congress is generally free to choose how statutes relate to each other. Id. at 544. According to the Court, Congress's decision not to label certain exactions as taxes, especially in light of labelling several other exactions as taxes elsewhere in the ACA, was an expression of its intent as to how the individual mandate should relate to other statutory provisions applicable to taxes, such as the Anti-Injunction Act. Id. The Court thus rejected an approach that considered whether the individual mandate "function[ed] like a tax," and held that Congress's label as a "penalty" meant that the Anti-Injunction Act did not apply. Id. at 544-546.
Plaintiff counters that the decision in NFIB as to the applicability of the Anti-Injunction Act is not determinative. (ECF No. 19, at 28). Plaintiff appears to be arguing that, although "a decision that a premium is a tax for the purposes of the Anti-Injunction [Act] necessarily is a decision that an objection to that assessment must be litigated in a tax refund action" under the Tax Refund Statute, Pittston Co., 199 F.3d at 702, a decision that a premium is not a tax for the purposes of the Anti-Injunction Act does not necessarily mean that the exaction does not qualify as a tax under the Tax Refund Statute (ECF No. 19, at 28). Plaintiff emphasizes that the Anti-Injunction Act addresses the timing of the filing of a claim, whereas the Tax Refund Statute addresses whether and where a claim can be brought at all. (Id.).
Plaintiff's arguments ignore the reasoning in the Supreme Court's opinion in NFIB.
The Government's NFIB argument is bolstered by two Fourth Circuit decisions as to insurance mandates from the ACA. In Liberty University, Inc. v. Geithner, 671 F.3d 391, 404-06 (4
Curiously, Plaintiff's opposition, without citing to the vacated Liberty I opinion, incorporates its language and citations nearly word for word to support its argument that the "essential character" of the exaction overrides congressional labels. (Compare ECF No. 19, at 21-22, with Liberty I, 671 F.3d at 404). That analysis is no longer applicable after NFIB and Liberty II.
Here, Congress labelled the reinsurance mandate a "payment" and a "contribution." See 42 U.S.C. §§ 10861(b). In addition to these labels, Congress required that these reinsurance contributions be paid to third-party reinsurance entities as opposed to the IRS, placed oversight of the TRP with the Secretary of Health and Human Services as opposed to the IRS or the Secretary of Treasury, and codified these provisions in Title 42 of the U.S. Code as opposed to the Internal Revenue Code.
Plaintiff next argues that, even if the reinsurance mandate is not a tax, it qualifies under the Tax Refund Statute's "any sum" provision. (ECF No. 19, at 29-30). As noted above, the Tax Refund Statute also applies to "any sum alleged to have been excessive or in any manner wrongfully collected under the internal-revenue laws." 28 U.S.C. § 1346(a)(1). Plaintiff points to Flora v. United States, 362 U.S. 145, 149 (1960) ("Flora II"), in which the Court held that the "tax," "penalty," and "any sum" provisions should be read disjunctively, such that "`any sum,' instead of being related to `any internal-revenue tax' and `any penalty,' may refer to amounts which are neither taxes nor penalties." Plaintiff contends that "Congress included the `any sum' language to ensure a broad interpretation of the statute." (ECF No. 19, at 30).
In the alternative, Plaintiff asserts that jurisdiction exists under the waiver of sovereign immunity in the Administrative Procedure Act ("APA"), 5 U.S.C. § 702. (ECF No. 19, at 36). The APA provides that "[a] person suffering legal wrong because of agency action, or adversely affected or aggrieved by agency action within the meaning of a relevant statute, is entitled to judicial review thereof." 5 U.S.C. § 702. This waiver of sovereign immunity is limited, however, to actions "seek[ing] relief other than money damages." Id. The Government argues that the APA's waiver of sovereign immunity does not apply because Plaintiff seeks money damages here. (ECF No. 18-1, at 20).
Plaintiff does not dispute that the damages it seeks are money damages as defined in the APA. Instead, Plaintiff argues that its claim for declaratory relief from the reinsurance payments on behalf of those class members who have yet to make the payments satisfies the APA requirement. (ECF No. 19, at 36). Even if Plaintiff could show that such a claim for declaratory relief met the APA standard, this case must be dismissed because Plaintiff itself could not bring such a claim. Plaintiff has submitted its reinsurance payments and now seeks damages for the fees it has already paid. It is well established that courts "analyze standing based on the allegations of personal injury made by the named plaintiffs." Beck v. McDonald, 848 F.3d 262, 269 (4
Plaintiff cannot show that any waiver of sovereign immunity applies to its claims. Therefore, the court has no jurisdiction, and the Government's motion to dismiss will be granted.
For the foregoing reasons, the motion to dismiss filed by the Government will be granted. A separate order will follow.
See also, Batsche v. Burwell, 210 F.Supp.3d 1130, 1136 (D.Minn. 2016). The parties have not sought a transfer to that court, see 28 U.S.C. § 1631, and the court declines to consider that alternative sua sponte.