St. Louis Effort for Aids v. Huff

782 F.3d 1016

ST. LOUIS EFFORT FOR AIDS ; Planned Parenthood of the St. Louis Region and Southwest Missouri; Consumers Council of Missouri; Missouri Jobs With Justice ; Jeanette Mott Oxford; Dr. Wayne Letizia; Dr. William Fogarty; Chris Worth Plaintiffs–Appellees

v.Director John M. HUFF, in his official capacity as the Director of the Missouri Department of Insurance, Financial Institutions and Professional Registration Defendant–Appellant.

Missouri Association of Insurance Agents, Amicus on Behalf of Appellant

AARP; Sargent Shriver National Center on Poverty Law, Amici on Behalf of Appellees.

No. 14–1520.

United States Court of Appeals, Eighth Circuit.

Submitted: Jan. 14, 2015.

Filed: April 10, 2015.

Jeremiah J. Morgan, Asst. Atty. Gen., Jefferson City, MO, argued (Chris Koster, Atty. Gen., on the brief), for appellant.

Thomas W. Rynard, Blitz, Bardgett & Deutsch, L.C., Jefferson City, MO, argued (James B. Deutsh, Marc H. Ellinger, on the brief), for amicus curiae Mo. Ass'n of Ins. Agents, in support of appellant.

Jay Angoff, Mehri & Skalet, PLCC, Washington, DC, argued (Ingrid Babri, Mehri & Skalet, PLLC, Washington, DC, Jane Perkins, Abbi Coursolle, National Health Law Program, Carrboro, NC, on the brief), for appellees.

Margaret Stapleton, Sargent Shriver National Center on Poverty Law, Chicago, IL, Jay E. Sushelsky, Andrew Strickland, AARP, Washington, DC, for amici curiae AARP and Sargent Shriver National Center on Poverty Law, in support of appellees.

Before RILEY, Chief Judge, BEAM and COLLOTON, Circuit Judges.

Opinion

RILEY, Chief Judge.

St. Louis Effort for AIDS, Planned Parenthood of the St. Louis Region and Southwest Missouri (Planned Parenthood) (collectively, appellees), and a number of other individuals and entities brought this facial challenge to Missouri's Health Insurance Marketplace Innovation Act (HIMIA), Mo.Rev.Stat. § 376.2000 et seq. The plaintiffs sought a preliminary injunction, claiming certain portions of the HIMIA are preempted by federal law, violate the First Amendment to the United States Constitution, and are void for vagueness under the Due Process Clause of the Fourteenth Amendment. Enjoining the HIMIA in its entirety, the district court held the appellees—but not the other named plaintiffs—were likely to succeed on the merits of their preemption claim. John Huff, in his capacity as Director of the Missouri Department of Insurance, Financial Institutions and Professional Registration, appeals. We affirm in part and otherwise vacate the preliminary injunction and remand the case to the district court.¹

I. BACKGROUND

The Patient Protection and Affordable Care Act (ACA) created “navigators”—individuals who assist consumers in purchasing health insurance from state and federal health care exchanges. See 42 U.S.C. § 18031(i). The ACA granted the Secretary of the United States Department of Health and Human Services (HHS) the power to “establish standards for navigators,” id. § 18031(i)(4)(A), and more generally, to “issue regulations setting standards for ... the establishment and operation of Exchanges,” id. § 18041(a)(1)(A). HHS regulations recognize three categories of individuals who facilitate enrollment in exchanges: federal navigators, certified application counselors (CACs), and non-navigator assistance personnel.² See 45 C.F.R. §§ 155.210, 155.215, 155.225. Because the primary goal of both federal navigators and CACs is to facilitate enrollment in exchanges, they conduct many of the same activities. Compare 42 U.S.C. § 18031(i)(3), and 45 C.F.R. § 155.210(e), with 45 C.F.R. § 155.225(c). Still, federal navigators have a more extensive set of duties than CACs, and only federal navigators receive federal monetary grants. See 42 U.S.C. § 18031(i)(1), (3). The appellees are both federally certified as counselor designated organizations and employ individuals working as CACs.³

Acting under the ACA, the federal government established a Federally-facilitated Exchange (FFE) in Missouri, and federal navigators and CACs assist in the operation of this exchange. The Missouri legislature enacted the HIMIA to regulate “person[s] that, for compensation, provide[ ] information or services in connection with eligibility, enrollment, or program specifications of any health benefit exchange operating in [Missouri].”⁴ Mo.Rev.Stat. § 376.2000.2(4). The HIMIA includes licensing provisions, see, e.g., id. §§ 376.2004, 376.2006, and regulatory provisions, see, e.g., id. §§ 376.2002, 376.2008. The regulatory provisions dictate what state navigators can do, see, e.g., id. § 376.2002.2, and more relevant to this appeal, what state navigators cannot do unless they are also licensed insurance producers, see, e.g., id. § 376.2002.3. The HIMIA also includes a remedial provision, allowing Huff to impose restrictions on a state navigator's license or levy a fine of up to $1000 for certain misconduct “or for other good cause.” Id. § 376.2010.1.

The appellees brought the current suit seeking to enjoin preliminarily the HIMIA before its enforcement. The appellees challenged several specific HIMIA provisions, including: the definition of state navigators, see id. § 376.2000.2(4) ; three “substantive provisions,” see id. §§ 376.2002.3(3), (5), 376.2008 ; and the “remedial provision,” see id. § 376.2010.1.

The district court granted the preliminary injunction, stopping the HIMIA's enforcement against federal navigators and CACs. Applying the familiar four-part test for preliminary injunctions, see Dataphase Sys., Inc. v. C L Sys., Inc., 640 F.2d 109, 113 (8th Cir.1981), the district court found the appellees were likely to succeed on the merits⁵ because the ACA preempts the HIMIA. The district court reasoned:

[T]he Court is of the view that any attempt by Missouri to regulate the conduct of those working on behalf of the FFE is preempted.... Missouri has opted not to be in the health insurance exchange business. Having made the choice to leave the operation of the exchange to the federal government, Missouri cannot choose to impose additional requirements or limitations on the exchange. Doing so frustrates Congress' purpose of having HHS operate FFEs in states where no exchange exists.

Finding the other three prongs of the preliminary injunction test also favored the appellees, the district court issued the injunction “preliminarily enjoin[ing]” Huff “from enforcing HIMIA.” Huff appeals, challenging the district court's conclusion that the appellees were likely to succeed on the merits. We affirm the district court's order enjoining the HIMIA's enforcement against CACs as to the three challenged substantive provisions—Mo. Rev. Stat. §§ 376.2002.3(3), (5) and 376.2008 —but reverse to the extent the order applies to federal navigators or any other portion of the HIMIA.

II. DISCUSSION

When granting a preliminary injunction, district courts apply “ ‘a flexible consideration of (1) the threat of irreparable harm to the moving party; (2) balancing this harm with any injury an injunction would inflict on other interested parties; (3) the probability that the moving party would succeed on the merits; and (4) the effect on the public interest.’ ” Minn. Citizens Concerned for Life, Inc. v. Swanson, 692 F.3d 864, 870 (8th Cir.2012) (en banc) (quoting Planned Parenthood Minn., N.D., S.D. v. Rounds, 530 F.3d 724, 729 n. 3 (8th Cir.2008) (en banc)). “The decision to grant or deny a preliminary injunction rests within the discretion of the district court and will not be disturbed on appeal absent a showing of abuse of discretion.” United States v. Gannaway, 536 F.2d 784, 786 (8th Cir.1976). “When purely legal questions are presented, however, this court owes no special deference to the district court,” Lankford v. Sherman, 451 F.3d 496, 504 (8th Cir.2006), and we review “its legal conclusions de novo,” Goss, 491 F.3d at 362.

A. Preemption

“The general law of preemption is grounded in the Constitution's command that federal law ‘shall be the supreme Law of the Land.’ ” In re Aurora Dairy Corp. Organic Milk Mktg. & Sales Practices Litig., 621 F.3d 781, 791 (8th Cir.2010) (quoting U.S. Const. art. VI, cl. 2 ). “Congress does not cavalierly pre-empt state-law causes of action.” Medtronic, Inc. v. Lohr, 518 U.S. 470, 485, 116 S.Ct. 2240, 135 L.Ed.2d 700 (1996). “ ‘In the interest of avoiding unintended encroachment on the authority of the States, ... a court interpreting a federal statute pertaining to a subject traditionally governed by state law will be reluctant to find pre-emption.’ ” Heart of Am. Grain Insp. Serv., Inc. v. Mo. Dep't of Agric.,

123 F.3d 1098, 1103 (8th Cir.1997) (quoting CSX Transp., Inc. v. Easterwood, 507 U.S. 658, 663–64, 113 S.Ct. 1732, 123 L.Ed.2d 387 (1993) ). We thus will not find a law preempted unless it “ ‘was the clear and manifest purpose of Congress,’ ” which “ ‘may be indicated through a statute's express language or through its structure and purpose.’ ” Aurora Dairy, 621 F.3d at 792 (quoting Medtronic, 518 U.S. at 485, 116 S.Ct. 2240, and Altria Grp., Inc. v. Good, 555 U.S. 70, 76, 129 S.Ct. 538, 172 L.Ed.2d 398 (2008) ).

“Because the [ACA] contains an express preemption clause, we focus in the first instance on the plain language of the statute, because it ‘necessarily contains the best evidence of Congress' pre-emptive intent.’ ” Chapman v. Lab One, 390 F.3d 620, 625 (8th Cir.2004) (quoting CSX Transp., 507 U.S. at 664, 113 S.Ct. 1732 ). Section 18041(d) of Title 42 —titled “No interference with State regulatory authority”—states, “Nothing in this title shall be construed to preempt any State law that does not prevent the application of the provisions of this title.” This preemption clause is a narrow one, and only those state laws that “hinder or impede” the implementation of the ACA run afoul of the Supremacy Clause. Black's Law Dictionary 1226 (8th ed.2004) (defining “prevent”).

The district court ignored § 18041(d)'s limited preemptive effect. After invalidating the licensing requirements in Mo.Rev.Stat....