DocketNumber: No. 16–149.
Judges: Ginsburg, Thomas
Filed Date: 4/18/2017
Status: Precedential
Modified Date: 10/19/2024
In the Federal Employees Health Benefits Act of 1959 (FEHBA),
"The terms of any contract under this chapter which relate to the nature, provision, or extent of coverage or benefits (including payments with respect to benefits) shall supersede and preempt any State or local law, or any regulation issued thereunder, which relates to health insurance or plans."
Contracts OPM negotiates with private carriers provide for reimbursement and subrogation. Reimbursement requires an insured employee who receives payment from another source (e.g., the proceeds yielded by a tort claim) to return healthcare costs earlier paid out by the carrier. Subrogation involves transfer of the right to a third-party payment from the insured employee to the carrier, who can then pursue the claim against the third party. Several States, however, Missouri among them, bar enforcement of contractual subrogation and reimbursement provisions.
The questions here presented: Does FEHBA's express-preemption prescription, § 8902(m)(1), override state law prohibiting subrogation and reimbursement; and if § 8902(m)(1) has that effect, is the statutory prescription consistent with the Supremacy Clause, U.S. Const. Art. VI, cl. 2 ? We hold, contrary to the decision of the Missouri Supreme Court, that contractual subrogation and reimbursement prescriptions plainly "relate to ... payments with respect to benefits," § 8902(m)(1) ; therefore, by statutory instruction, they override state law barring subrogation and reimbursement. We further hold, again contrary to the Missouri Supreme Court, that the regime Congress enacted is compatible with the Supremacy Clause. Section 8902(m)(1) itself, not the contracts OPM negotiates, triggers the federal preemption. As Congress directed, where FEHBA contract terms "relate to the nature, provision, or extent of coverage or benefits (including payments with respect to benefits)," § 8902(m)(1) ensures that those terms will be uniformly enforceable nationwide, free from state interference.
I
A
FEHBA "establishes a comprehensive program of health insurance for federal employees." Empire Healthchoice Assurance, Inc. v. McVeigh,
*1195contains an express-preemption provision, § 8902(m)(1). FEHBA assigns to OPM broad administrative and rulemaking authority over the program. See §§ 8901 - 8913. OPM contracts with private insurance carriers to offer a range of healthcare plans. §§ 8902, 8903.
OPM's contracts with private carriers have long included provisions requiring those carriers to seek subrogation and reimbursement. Accordingly, OPM has issued detailed regulations governing subrogation and reimbursement clauses in FEHBA contracts. See
In 2015, after notice and comment, OPM published a rule confirming that "[a] carrier's rights and responsibilities pertaining to subrogation and reimbursement under any [FEHBA] contract relate to the nature, provision, and extent of coverage or benefits (including payments with respect to benefits) within the meaning of" § 8902(m)(1). § 890.106(h). Such "rights and responsibilities," OPM's rule provides, "are ... effective notwithstanding any state or local law, or any regulation issued thereunder, which relates to health insurance or plans."
B
Respondent Jodie Nevils is a former federal employee who enrolled in and was insured under a FEHBA plan offered by petitioner Coventry Health Care of Missouri.
Nevils then filed this class action against Coventry in Missouri state court, alleging that Coventry had unlawfully obtained reimbursement.
The Missouri Supreme Court reversed. Nevils I,
Judge Wilson, joined by Judge Breckenridge, concurred in the judgment.
Coventry sought our review, and we invited the Solicitor General to file a brief expressing the views of the United States. Coventry Health Care of Mo., Inc. v. Nevils, 574 U.S. ----,
On remand, the Missouri Supreme Court adhered to its earlier decision. Nevils v. Group Health Plan, Inc.,
Judge Wilson again concurred, this time joined by a majority of the judges of the Missouri Supreme Court.
We granted certiorari to resolve conflicting interpretations of § 8902(m)(1). 580 U.S. ----,
II
Section 8902(m)(1) places two preconditions on federal preemption. See supra, at 1194. The parties agree that Missouri's law prohibiting subrogation and reimbursement meets one of the two limitations, i.e., the State's law "relates to health insurance or plans." § 8902(m)(1). They dispute only whether the subrogation and reimbursement requirements in OPM's contract with Coventry "relate to the nature, provision, or extent of coverage or benefits," "including payments with respect to benefits." Ibid.
Coventry contends that § 8902(m)(1) unambiguously covers the contractual terms *1197at issue here. In any event, Coventry, joined by the United States as amicus curiae, urges that the rule published by OPM in 2015 leaves no room for doubt that insurance-contract terms providing for subrogation and reimbursement fall within § 8902(m)(1)'s preemptive scope. See supra, at 1195. Deference is due to OPM's reading, Coventry and the United States assert, under Chevron U.S.A. Inc. v. Natural Resources Defense Council, Inc.,
A
Contractual provisions for subrogation and reimbursement "relate to ... payments with respect to benefits" because subrogation and reimbursement rights yield just such payments. When a carrier exercises its right to either reimbursement or subrogation, it receives from either the beneficiary or a third party "payment" respecting the benefits the carrier had previously paid. The carrier's very provision of benefits triggers the right to payment. See Tr. of Oral Arg. 31; Helfrich,
Congress' use of the expansive phrase "relate to" shores up that understanding. We have "repeatedly recognized" that the phrase "relate to" in a preemption clause "express[es] a broad pre-emptive purpose." Morales v. Trans World Airlines, Inc.,
The statutory context and purpose reinforce our conclusion. FEHBA concerns "benefits from a federal health insurance plan for federal employees that arise from a federal law" in an area with a "long history of federal involvement." Bell,
B
Invoking our suggestion in McVeigh that § 8902(m)(1) has two "plausible" interpretations,
In McVeigh, we considered the discrete question whether
The carrier in McVeigh, as part of its argument in favor of federal jurisdiction, asserted that § 8902(m)(1) itself conferred federal jurisdiction. See
We made no choice between the two interpretations set out in McVeigh, however, because the answer made no difference to the question there presented.
III
Nevils further contends that, if § 8902(m)(1) covers subrogation and reimbursement clauses in OPM contracts, then the statute itself would violate the Supremacy Clause by assigning preemptive effect to the terms of a contract, not to the laws of the United States. We conclude, however, that the statute, not a contract, strips state law of its force.
Without § 8902(m)(1), there would be no preemption of state insurance law. FEHBA contract terms have preemptive force only as they "relate to the nature, provision, or extent of coverage or benefits (including payments with respect to benefits)," § 8902(m)(1) -i.e., when the contract terms fall within the statute's preemptive scope. It is therefore the statute that "ensures that [FEHBA contract] terms will be uniformly enforceable nationwide, notwithstanding any state law relating to health insurance or plans." Brief for United States as Amicus Curiae 28 (internal quotation marks omitted).
Many other federal statutes preempt state law in this way, leaving the context-specific scope of preemption to contractual terms. The Employee Retirement Income Security Act of 1974 (ERISA),
Nevils instead attempts to distinguish those other statutes by highlighting a particular textual feature of § 8902(m)(1) : Section 8902(m)(1) states that the "terms of any contract " between OPM and a carrier "shall supersede and preempt" certain state or local laws. (Emphasis added.) That formulation, Nevils asserts, violates the Supremacy Clause's mandate that only the "Laws of the United States" may reign supreme over state law. U.S. Const. Art. VI, cl. 2 (emphasis added). Nevils' argument elevates semantics over substance. While Congress' formulation might differ from the phrasing of other statutes, § 8902(m)(1) manifests the same intent to preempt state law.
For the reasons stated, the judgment of the Supreme Court of Missouri is reversed, and the case is remanded for further proceedings not inconsistent with this opinion.
It is so ordered.
Justice GORSUCH took no part in the consideration or decision of this case.
Coventry was formerly known as Group Health Plan, Inc. Pet. for Cert. ii. We refer to both the current and former entities as "Coventry."
Under Missouri law, a "concurring opinion" in which "a majority of the court concur[s]" is binding precedent. Mueller v. Burchfield,
Because the statute alone resolves this dispute, we need not consider whether Chevron deference attaches to OPM's 2015 rule.
Congress' choice of language is not unique to § 8902(m)(1). Several related statutes governing federal-employee and military-member benefits employ similar formulations. See § 8959 ("The terms of any contract that relate to the nature, provision, or extent of coverage or benefits (including payments with respect to benefits) shall supersede and preempt any State or local law, or any regulation issued thereunder, which relates to dental benefits, insurance, plans, or contracts."); § 8989 (same for vision); § 9005(a) (same for long-term care);
Nevils' speculation about the Government's outsourcing preemption to private entities, see Brief for Respondent 24, is far afield from the matter before us. This case involves only Congress' preemption of state insurance laws to ensure that the terms in contracts negotiated by OPM, a federal agency, operate free from state interference.
* * *