National Coal Ass'n v. Chater, 95-6781

Decision Date26 April 1996
Docket NumberNo. 95-6781,95-6781
Citation81 F.3d 1077
PartiesNATIONAL COAL ASSOCIATION, Alabama Land and Mineral Corporation, Allied Signal, Inc., Berwind Corporation, Bethlehem Steel Corporation, Costain Coal, Inc., LTV Steel Company, Mountain Laurel Resources Company, The Pittston Company, Plaintiffs-Appellees, v. Shirley S. CHATER, Commissioner of Social Security, Defendant-Appellant.
CourtU.S. Court of Appeals — Eleventh Circuit

Alan Frank, U.S. Dept. Health and Human Services, Jeffrey Clair, U.S. Dept. of Justice, Civ.Div., Washington, DC, for appellant.

Willis J. Goldsmith, Jones Day Reavis & Poge, Washington, DC, John R. Woodrum, Ronald E. Meisburg, Jennifer L. Kim, Smith Heenan & Althen, Washington, DC, for appellees.

Appeal from the United States District Court for the Northern District of Alabama.

Before TJOFLAT, Chief Judge, COX, Circuit Judge, and CLARK, Senior Circuit Judge.

PER CURIAM:

The Commissioner of Social Security appeals from a grant of summary judgment for the plaintiffs, requiring her to recompute premiums paid by coal operators under a federal statute that creates a benefits plan for mine workers. The sole issue in this appeal is the meaning of the word "reimbursements" as used in the statutory formula for calculating health benefit premiums. We affirm the district court.

I. Background

The financial instability of health and retirement benefit plans for mine workers and retirees historically has been a significant factor precipitating disputes between mine workers and coal operators. From 1946 to 1992, health benefits for miners were provided through a series of multiemployer plans created under agreements between the United Mineworkers of America (UMWA) and the National Bituminous Coal Operators' Association. By 1989, the two multiemployer plans that provided health benefits to retirees, the 1950 UMWA Benefit Plan and Trust, and the 1974 UMWA Benefit Plan and Trust, were operating at a deficit. The financial instability of the plans led to a breakdown in labor relations: the Pittston Company ceased making contributions to the plans in 1990, and an eleven-month strike ensued. In re Chateaugay Corp., 53 F.3d 478, 484 (2d Cir.), cert. denied, --- U.S. ----, 116 S.Ct. 298, 133 L.Ed.2d 204 (1995).

Congress recognized the potential for continued disruption in the coal industry without an adequately funded source for the continued provision of benefits. With the aid of a study on the issue by a Department of Labor commission, 1 Congress passed the Coal Industry Retiree Health Benefit Act ("the Act"), Pub.L. No. 102-46, 106 Stat. 3036 (1992), codified at 26 U.S.C. §§ 9701-9722 (1994). The purpose of the Act was to remedy the problems in funding health care benefits for the beneficiaries of the former UMWA plans while retaining a benefits program that was privately financed. § 19142, 106 Stat. at 3037.

To accomplish this purpose, the Act basically consolidated the 1950 and 1974 UMWA Benefit Plans into one plan for the provision of health and retirement benefits called the UMWA Combined Benefit Fund ("Combined Fund"). 26 U.S.C. § 9702(a)(2). The Act directed the Secretary of Health and Human Services ("Secretary of HHS") to assign eligible beneficiaries of the Combined Fund to coal operators according to certain criteria; a 1994 amendment to the Act replaced the Secretary with the Commissioner of Social Security ("Commissioner"). 26 U.S.C. § 9706; Social Security Independence and Program Improvements Act, Pub.L. No. 103-296, § 108(h)(9)(A), 108 Stat. 1464, 1487. Assigned coal operators finance the Combined Fund by paying annual per-beneficiary premiums as directed by the Act. 26 U.S.C. § 9704(a). The portion of the annual premium for health benefits is calculated by the Commissioner using a formula in § 9704(b)(2), which reads in part:

The Commissioner ... shall calculate a per beneficiary premium for each plan year beginning on or after February 1, 1993, which is equal to the sum of--

(A) the amount determined by dividing--

(i) the aggregate amount of payments from the 1950 UMWA Benefit Plan and the 1974 UMWA Benefit Plan for health benefits (less reimbursements but including administrative costs) for the plan year beginning July 1, 1991, for all individuals covered under such plans for such plan year, by

(ii) the number of such individuals ... 2

26 U.S.C. § 9704(b)(2) (emphasis added). The meaning of the word "reimbursement" in this section is the sole issue disputed by the parties to this appeal.

In order to understand the controversy in this case, it is important to understand how the 1950 and 1974 UMWA Benefit Plans acted in combination with government benefits programs, like Medicare, to provide health care services for beneficiaries. Health care coverage under the former UMWA plans was limited to services that were not covered by Medicare or other government benefit programs. But to promote efficiency for the payors and convenience for the beneficiaries, the UMWA plans entered into a series of agreements with the Health Care Financing Administration ("HCFA"), the governmental agency that administers Medicare, under which the UMWA plans would pay providers all the covered costs of the beneficiaries' health care. Medicare would then reimburse the UMWA plans for services covered by Medicare Part B 3 and related administrative costs.

Prior to June of 1990, the payments made by HCFA pursuant to its agreement with the UMWA plans were calculated on a traditional cost basis. The UMWA plans submitted reports of Medicare services actually received by their beneficiaries, and HCFA used Medicare cost principles to calculate the appropriate payment to the benefit plans. The process of calculating cost-based reimbursement for benefit plans of this size was complicated, and disputes frequently arose over the amount that HCFA would pay the UMWA plans.

In 1990, the UMWA plans and HCFA signed a new contract that employed a risk-capitation method for calculating the payments from HCFA to the benefit plans. (R. 2-28 Defs.' Ex. 5.) Under the new method, HCFA paid a predetermined amount per plan member per month, without regard to the amount of money that the UMWA plans actually spent on Medicare-covered services. The risk-capitation method was considered desirable by both parties. The UMWA plans hoped that using this method would prevent the protracted disputes that had occurred over the amount of the HCFA payments. HCFA favored the risk-capitation method because it gave the UMWA plans the incentive to provide Medicare-covered services more efficiently, and because the amount of its payment to the plans would be more certain.

The contract between HCFA and the UMWA plans using the risk-capitation method has been renewed every year since its inception; the Combined Fund has been substituted for the UMWA plans. The 1990 contract, as well as each of the renewal contracts in the record, characterize the payment made by HCFA to the UMWA plans under the contract alternatively as a "payment" or "capitation payment", and as "reimbursement." (R. 2-28 Defs.' Exs. 5, 6, 7.) 4

The Act requires the trustees of the Combined Fund to submit to the Commissioner "information as to the benefits and covered beneficiaries under the fund, and such other information as the [Commissioner] may require to compute any premium under this section." 26 U.S.C. § 9704(h). In September of 1993, the trustees submitted a financial report for the 1992 plan year ("base year") to the Secretary of HHS, the Commissioner's predecessor under the Act. The report showed that in the base year, the UMWA plans spent $156.8 million on Medicare Part B services and related administrative expenses. The report also showed that, pursuant to their contract with HCFA, the plans received $182.3 million in risk-capitation payments for Medicare Part B services and related administrative costs, an amount that exceeded actual costs by about $25.5 million.

Under the formula in 26 U.S.C. § 9704 for the calculation of the per beneficiary health benefit premiums, one factor is the amount of "reimbursements" received by the plans during the base year. 26 U.S.C. § 9704(b)(2). In calculating this premium, the Secretary used the amount actually paid by the UMWA plans during the base year for Medicare Part B and related administrative costs, or $156.8 million, as "reimbursements" to arrive at an annual per beneficiary premium of $2,245.33 for assigned coal operators. If the Secretary had used the amount received by the UMWA plans from HCFA under the risk-capitation contract, or $182.3 million, as "reimbursements," the per beneficiary premium would have been about $2,013.83.

II. Proceedings Below

In April of 1994, the National Coal Association ("NCA") and eight companies who are assigned premium payment obligations under the Act filed suit in federal district court, 5 alleging that the Secretary violated the Act by miscalculating the health benefit premium. Finding that there were no disputed issues of fact between the parties, the district court addressed the contentions of the parties on cross motions for summary judgment. The court held that the word "reimbursements" in the Act clearly and unambiguously referred to the entire amount of payments made by HCFA to the UMWA plans pursuant to the contract. Because the court held that Congress had precisely addressed the issue before it, the court rejected the Secretary's argument that her interpretation of "reimbursement" was entitled to deference under Chevron, U.S.A., Inc. v. Natural Resources Defense Council, Inc., 467 U.S. 837, 104 S.Ct. 2778, 81 L.Ed.2d 694 (1984). The court granted the plaintiffs' motion, and ordered the Commissioner to recalculate the health benefit premium using the amount of the risk-capitation payments as "reimbursements." The Commissioner appeals.

III. Issue on Appeal and Standard of Review

The parties to this appeal do not disagree on any issue of fact. The sole issue in...

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