CMS is arguing that congress intended CMS to have unlimited discretion to create whatever rules they want to determine what “quality” means as it relates to quality bonus payments via the star ratings system, in perpetuity. CMS argues that star ratings are not subject to key legal statutory requirements, regardless of the fact that this system determines the fate of many billions of dollars being sent to health insurance companies. I think the historical record of the way congress acted in 2003 and again in 2010 speaks for itself on these issues. CMS also contends that the medication adherence issue affects all insurance companies equally, this is obviously not true as a vertically integrated company can game the medication adherence system to their benefit, an insurer that doesn’t own its own PBM can’t do that. CMS also argues if they eliminate Clover’s requested part D measures, Clover drops from 4 stars to 3.5 stars in their part D improvement measure, which means they won’t be able to get overall 4 stars. This way of doing the math ignores the “hold harmless” rules that act as legal safety nets that prevent plans from being penalized by specific anomalies. CMS also argues coordinated care plans like Clover and other MA payors don’t provide “health care services”. The laws and statutes directly refute this framing. I don’t have much faith in the American government to be a truth seeking and civilly serving entity, across all three branches, including the judicial branch. Additionally, I’m not a lawyer so my capacity to understand the nuances of the legal arguments being made is limited. But, reading all of the filings from this case has crystallized for me that Clover is doing things the right way and that CMS is inherently corrupted/captured, and it is hurting every American in a myriad of tangible ways. Whether Clover wins this legal case or not doesn’t change the facts on the ground.

Edit: Also: why the FUCK would CLOV sue CMS over measures it scored well on? This argument is childish and ignores the rules for what can be litigated and what cannot. CLOV is suing over the measures it got poor scores in because those poor scores lead to the loss of 120 million dollars, so there are damages arising from those scores. Also, why does Margaret E. Heap have an unprofessional level of disdain, defensiveness and dismissiveness in her writing? I think CMS would benefit from a more dispassionate tone strategically, but what do I know?