Effects of the Affordable Care Act on Future Medical Cost Claims
The Patient Protection and Affordable Care Act (“ACA”) should dramatically change what an uninsured plaintiff can legitimately claim and recover for future medical and non-medical care costs. The ACA is of particular importance when attempting to reduce the projected costs of a plaintiff’s life care plan in a catastrophic injury case.
The ACA mandates that “a health insurance issuer offering group or individual health insurance coverage may not impose any preexisting condition exclusion with respect to such plan or coverage.” 42 U.S.C.A. § 300gg-3(a) (West 2015). In addition, the ACA requires that all health insurance plans provide “essential health benefits.” 42 U.S.C.A. § 18022 (West 2015). The wide range of essential health benefits includes: hospitalization; mental health services; prescription drugs; laboratory services; preventative and wellness services; chronic disease management; pediatric services, including oral and vision care; and rehabilitative/habilitative services and devices, which include prosthetics and wheelchairs as well as physical and occupational therapy. See 42 U.S.C.A. § 18022(b). The ACA caps an individual’s out-of-pocket expenses. 42 U.S.C.A. § 18022(c)(1). Presently, this cap is $6,600 per year for individuals and $13,200 for families.
Any suggestion by a plaintiff that she may simply elect not to purchase private health insurance under the ACA should fail. This is because a plaintiff “cannot recover damages resulting from consequences which [s]he could reasonably have avoided by reasonable care, effort or expenditure.” Bill C. Harris Constr. Co. Inc. v. Powers, 262 Ark. 96, 104−05, 554 S.W.2d 332, 336 (1977). Purchasing health insurance to cover preexisting conditions is no longer unreasonable or impracticable. Indeed, it is now required by federal law and available to everyone. 26 U.S.C.A. § 500A (West 2015).
Typically, a plaintiff will argue that the ACA is inadmissible under a state’s collateral source rule. The collateral source rule exists to avoid rewarding a tortfeasor by reducing damages because the plaintiff had the foresight to purchase insurance. Since the policy underlying the rule does not apply to an uninsured plaintiff, courts are beginning to reject the collateral source argument. See, e.g., Brewington v. United States, No. CV 13−07672−DMG (CWx), 2015 WL 4511296, at *6−7 (C.D. Cal July 24, 2015) (finding “it appropriate to take insurance benefits available under the ACA into consideration in calculating reasonable future life care plan needs” where state law requires “plaintiffs to take reasonable steps to mitigate [their] damages and bars recovery for any losses which could have been thus avoided”).
In accordance with the legal duty to exercise reasonable care in minimizing damages, an uninsured plaintiff must purchase insurance coverage available through and required by the ACA. Courts allowing otherwise misinterpret the collateral source rule and deprive defendants of their fundamental right to a fair trial. While an injured plaintiff is entitled to put forth evidence of the reasonable costs of future medical and non-medical costs, no defendant should be required to compensate a plaintiff for damages that the plaintiff could have reasonably avoided. As tort reform continues, hopefully courts will continue to consider the admissibility of the Affordable Care Act to prevent unjust windfall recoveries by plaintiffs.
Paul D. Waddell (firstname.lastname@example.org)
Samuel T. Waddell (email@example.com)