FARGO—Sanford Health Plan is suing the federal government for almost $9 million for what it says is a reneged promise to pay to cushion the insurer against hard-to-predict losses from providing coverage under the Affordable Care Act.
The Affordable Care Act, the health reform law often called Obamacare, required qualified health plans that sold health insurance in the government's online marketplace to meet certain standings, including providing essential benefits.
Insurers also were required to sell insurance with what is called "community rating," basing premiums on the entire pool of customers instead of on individual health risks. Benefits previously subject to copays or other out-of-pocket payments from consumers were mandated to be provided at no cost to the insured.
Because of the high degree of uncertainty of providing mandated coverage for new populations, the Affordable Care Plan called upon the government to bolster insurers with programs to help stabilize premiums.