The Supreme Court had previously ruled in April 2020 that the federal government had to fully repay insurers for risk-corridor payments under the ACA. The court ruled insurers were entitled to more than $12 billion in unpaid payments. The risk corridor program ran from 2014 to 2016. It guaranteed payments to ACA exchange insurers that recorded certain losses. The goal was to help insurers navigate the new exchanges that went online in 2014.

However, the needed payments increased as the initial population on the ACA's exchanges was sicker than usual and plans were priced too low. A few months later, in August, the Court of Appeals for the Federal Circuit decided that the Supreme Court ruling meant payments were mandatory, too.

The court ruled that plans that engaged in the practice of "silver loading" were not entitled to full payments. Plans employed silver loading, where they added the amount of cost-sharing reductions to the second-cheapest silver plan, which also is the benchmark plan that the to which the federal government pegs subsidies. The result of silver loading was that subsidies went up, because the benchmark plan's cost increased.

This was the second ACA-related ruling in the past week. The high court in a 7-2 decision last Thursday rejected a Republican challenge to the law, the third time that the justices preserved the ACA over the past decade.