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Potential Defense under the Affordable Care Act

Given the expanded medical coverage provided for under the Affordable Care Act (“ACA”), the question has arisen as to the effect of this coverage on a personal injury plaintiff’s ability to recover future medical costs. Specifically, the ACA mandates all persons to carry health insurance and precludes insurance companies from denying coverage based on pre-existing conditions. Therefore, the ACA creates the legal argument that a personal injury Plaintiff’s damages for future medical costs should be limited to no more than the costs of their insurance premiums and deductibles. As such, the ACA provides defendants with a potential defense to limit recovery.

Presently though, no Pennsylvania court has yet to address this issue. Nonetheless, this issue has been addressed by other state courts. For example:

  • In a series of medical malpractice actions, the Minnesota courts considered any limitations the ACA placed on the recovery of future damage. In these cases, the defendants argued that future medical expenses should be limited because Plaintiff is not required to pay the full price of projected medical services under the ACA. They further argued that failing to reduce damages would result in a windfall to plaintiffs. Ultimately, though, the courts held that the state’s collateral source law precludes any reduction in a potential award for future medical expenses.[1]
  • While not ruling on the issue, New York courts have commented on this issue. In Caronia, the plaintiffs, smokers for 20+ years or more but had not yet been diagnosed with a smoking-related disease, sought to recover the cost of monitoring for future diseases. The court ruled that they could not because the plaintiffs had not yet sustained an injury. In a dissenting opinion, Chief Judge Lippman commented on defendants’ argument that future medicals should be limited under the terms of the ACA, as the plaintiffs would soon be able to obtain free access to such monitoring. While generally finding the argument unpersuasive, he acknowledged that there was a potential for an offset under the law for a reduction of the plaintiffs’ damages.[2]  In Cowden, Plaintiff sought to exclude evidence of potential coverage for future medical bills under the Affordable Care Act. The court deferred ruling, but stated that if the issue of future damages arises at trial, Defendant may be able to introduce the Affordable Care Act as a defense if it can come forward with authority that any coverage under Affordable Care Act does not constitute a collateral source.[3]
  • Finally, an Alabama court touched upon this issue as well. At trial, the plaintiff argued that defendant should be precluded from arguing the possibility that the Plaintiff may have medical insurance coverage in the future under the new Affordable Care Act. The court precluded such discussion, stating that “the possibility of discounts on past or future medical expense and the possibility of future insurance coverage would be too speculative to be relevant, or if relevant at all, any probative value of this evidence is substantially outweighed by the danger of confusion of the issues and misleading the jury.”[4]

Despite these cases touching upon this issue, by-in-large this is an undecided issue and is completely undeveloped in Pennsylvania. As such, until this issue is decided, personal injury defendants in Pennsylvania, and other states yet to decide this issue, should be cognizant of these potential defenses under the ACA.


[1] Halsne v. Health, 2014 U.S. Dist. LEXIS 37363, 27- (D. Minn. Mar. 21, 2014); Vasquez-Sierra v. Hennepin Faculty Assocs., No. 27-cv-12-1611, 2012 Minn. Dist. LEXIS 246, 2012 WL 7150829 (Minn. Dist. Ct. Dec. 14, 2012); see also Renswick v. Wenzel, 819 N.W.2d 198 (Minn. Ct. App. 2012).

[2] Caronia v Philip Morris USA, Inc., 5 N.E.3d 11, 19 (N.Y. 2013) (See dissenting opinion).

[3] Cowden v. BNSF Railway Company, 2013 U.S. Dist. LEXIS 155486, 54-55 (E.D.Mo., October 2013).

[4] Brewster v. Southern Home Rentals, LLC, 2012 U.S. Dist. LEXIS 173600 (M.D. Ala. Dec. 7, 2012).

Important NoticeThis information is intended for general guidance only, and should not be used as a substitute for specific legal advice.  For specific legal advice applicable to your situation, you should consult an attorney of your choice.  Although believed to be accurate when written, no guarantee of completeness or accuracy to your particular circumstances should be implied.  Laws, regulations, and court decisions in this area change frequently, and you should consult the attorney of your choice for up-to-date information.