Here and Now: Ohio Appellate Court Upholds Use of Affordable Care Act to Offset Damage Award for Future Medical Expenses.

August 2, 2016

Whether you applaud its ideal or urge its repeal, the Patient Protection and Affordable Care Act (“ACA”) is the law today. And with limited exception, this law requires all Americans to have health insurance and all insurance providers to cover pre-existing conditions.  As a result, the proper measure for future medical expenses for most claimants should be limited to the sum of the claimant’s annual insurance premium and applicable deductible multiplied by the number of years of required future care, right?  Despite debate nationwide, at least one Ohio Court of Appeals agrees.  See Jones v. MetroHealth Med. Ctr., 2016-Ohio-4858 (8th Dist.).

Jones involved a medical malpractice lawsuit against a hospital, which qualified as a political subdivision for purposes of R.C. 2744.05’s tort liability limitations.  The plaintiff alleged improper maternity care causing premature delivery of her child, who will need 24-hour attendant care for the remainder of his life.  After finding the hospital negligent, the jury awarded $14.5 million in economic and non-economic damages to the plaintiff and her child, including $8 million in future economic damages based upon the child’s life care plan.  However, that life care plan did not consider the fact that the child – who was twelve years old at the time of trial – would be required by the ACA to have health insurance until he qualified for Medicare at the age of twenty.  

Applying the ACA and R.C. 2744.05’s statutory offsets, the trial court reduced the $14.5 million award by nearly 80%.  The plaintiff appealed, arguing – among other things – that the future medical expenses were improperly offset because no one could be reasonably certain that either the ACA or Medicare would even exist in the future.  The Eighth District was not persuaded, recognizing that to accept such an argument on its face would: (a) “effectively bar all offsets because of the possibility that government programs might, someday, end;” and (b) require the court to ignore statutory law.  After removing future lost wages from the prior offset, the Eighth District affirmed both the constitutionality and effect of these offsets.  The following table illustrates the substantive impact of the Eighth District’s decision applying the ACA and R.C. 2744.05’s statutory offsets: 

Type of Damage

Original Jury Award

Appellate Judgment After Offset

Basis for Offset

Child’s past economic damage (i.e., medical expenses)

$500,000

$0

R.C. 2744.05(B)(1): collateral source

Child’s non-economic damages (i.e., pain & suffering)

$5,000,000

$250,000

R.C. 2744.05(C)(1): non-economic damages cap

Mother’s non-economic damages (i.e., pain & suffering)

$1,000,000

$250,000

R.C. 2744.05(C)(1): non-economic damages cap

Child’s future lost wages

$1,700,000

(presumed)

$1,700,000

(presumed)

None

Child’s future healthcare expenses (i.e., life care plan)

 

$6,300,000

 

$2,951,291

R.C. 2744.05(B)(1): collateral source, including ACA

TOTAL

$14,500,000

$5,151,291

 

Unsurprisingly, the plaintiff in Jones currently is seeking partial and en banc reconsideration of the Eighth District’s decision, both on the constitutionality of the non-economic damages cap and the effect of the statutory offsets, including the scope of the ACA’s application.  Assuming reconsideration is denied, all signs point to a showdown in the Supreme Court of Ohio sometime next year.  Until then, Jones offers healthcare defendants critical appellate precedent that is reflective of the law as it exists here and now.

 

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