Recently, an Ohio court, in Jones v. MetroHealth, Cuyahoga County Court of Common Pleas Case No.757131, recognized an argument by a defendant healthcare entity, reducing an award on the basis of the Affordable Care Act. The relevant arguments as to the Affordable Care Act’s limitations took place in this case in the context of a post-trial set-off hearing. The following are key points from the respective pleadings and court order:
- Relying on Buchman v. Board of Educ., 73 Ohio St. 3d 260, 266 (1995), the court held that an offset of damages on the basis of the Affordable Care Act was appropriate. The court noted,
All of the experts testified that [plaintiff] will qualify for Medicare at age twenty, and Plaintiffs’ argument that it is possible Medicare will not be available lacks merit. As it exists now, the evidence before the Court shows Medicare covers 80% of customary and ordinary care. Therefore, the expenses allocated to age twenty for all categories in the Life Care Plan, except Transportation, Home Care, and Housing should be set off in their entirety and the amount remaining should then be set off by 80% to account for what Medicare would cover, adding in the cost of care under the Affordable Care Act for the eight-year period until [plaintiff] becomes eligible for Medicare, and then deducting the previous three years allocated to Transportation. Therefore, after all of the deductions, [plaintiff]’s award for future economic damages should be reduced to $2,951,291 [from $8,000,000].
The court also acknowledged that, “At most, [plaintiff]’s premium under the ACA would be $8,000 per year, with $6,500 for maximum out-of-pocket expenses. Multiplying those expenses by the amount of years he could at most be ineligible for Medicaid and/or Medicare, his annual maximum totals $116,000.”
- Plaintiffs established the initial damage award by relying on economic/ life care experts, Mona Yudkoff and John Burke. At the post-trial hearing, plaintiff argued , unsuccessfully, that future damages were limited as insurance was not guaranteed to be available and that any setoff would be speculative.
- Defendant’s presented the testimony of “Certified Elder Law Attorney William J. Browning” to testify as to plaintiff’s eligibility for benefits in the future.
- It is also noteworthy that the collateral source rule appears to have been overcome through an Ohio statutory exception applying to “political subdivisions”. Thus, this still remains an issue in many cases where this or a similar exception does not apply.
Ultimately, while this case is not binding in Pennsylvania and does present aspects unique to Ohio law, it shows the potential viability and impact of a defense under the affordable care act. Given the potential effects of this defense on damages, exemplified by the Jones v. MetroHealth case, it is very likely that defendants will and should utilize this argument until Pennsylvania courts definitively rule on its applicability.
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