When the Patient Protection and Affordable Care Act (ACA) was signed into law on March 23, 2010, it appeared that injury victims
and advocates had dodged a potential bullet. The most widespread and drastic
reform of the national health care system since the establishment of Medicare
and Medicaid in the 1960s had passed after years of debate in Congress
and national media outlets. Further, the law would go into effect without
the “malpractice reform” measures that many had insisted would
be necessary to achieve the goals of increasing the number of Americans
covered by insurance and decreasing national health care costs.
The ACA, as enacted, seeks to increase access to health insurance coverage
by forbidding carriers from denying coverage based upon pre-existing conditions,
setting standards for “essential health services” that must be covered, and precluding yearly or lifetime limits on coverage
for those essential health services. The law also contains the well-known and oft-debated “individual
mandate” which requires all non-exempt U.S. citizens to maintain
health insurance coverage so as to avoid a tax penalty. The ACA does not, however, require individuals to purchase insurance coverage
through the marketplace established pursuant to the ACA, as it continues
to allow individuals to purchase coverage directly from a private carrier
or through their employer, while also providing exceptions for those covered
by government-sponsored health plans like Medicare and Medicaid. Notably absent from the final version of the bill were any provisions
placing additional caps on damage awards or limitations on attorney contingency
fees in medical negligence actions. Proposed amendments requiring pre-suit
alternative dispute resolution and the establishment of mandatory “health
tribunals” or “expert panel” systems at the state level
were also defeated prior to the ACA’s passage.
Despite the fact that medical malpractice actions and state civil justice
systems were virtually untouched by the language included in the 906 pages
of the ACA, tortfeasors and defense attorneys in Ohio and nationwide have
nonetheless attempted to use the law as a sword to reduce liabilities
and limit the ability of plaintiffs to receive full compensation. Arguments
that the individual mandate and annual out-of-pocket maximum provisions
of the ACA should place a ceiling on future medical expense damages and/or
negate the collateral source rule have become a common defense tactic
in catastrophic injury cases, both in the medical malpractice arena and
otherwise. Under the defense theory, “but for his injuries, the
victim would still have been required to hold insurance due to the mandate,
so the cost of purchasing this insurance is not attributable to his accident,
and the health insurance company is not allowed to charge a victim a higher
price due to his injuries.” Similarly, defense advocates have also attempted to introduce future “amounts
payable” under ACA marketplace plans as evidence of the reasonable
value of future medical treatment.
II. Recent Developments in Case Law
Much like the uncertainty created in the aftermath of
Robinson v. Bates in Ohio, motion practice regarding the interplay of the ACA and future
damage awards has led to contrasting results across various jurisdictions,
and uncertainty for practitioners. To date, the majority of courts facing
the issue have held that evidence of ACA benefits and annual maximum limits
are inadmissible as to the issue of future economic damages. That said, there are two recent opinions that defendants will argue support
the notion that they can reap the benefits of ACA health coverage to “cap”
life care plans and reduce their exposure at trial. In reality, however, these opinions are limited in their applicability,
and do not change the scope of damages available in most tort cases.
In Ohio, two trial court opinions have been issued in recent years that
raise concerns about an injured tort victim’s ability to obtain
full compensation for future life care plan expenditures with the ACA
now in effect. Both are often being cited and relied upon by defendants
in an effort to shift the responsibility for damages caused by negligence
away from the at-fault party and on to third-party health insurers offering
coverage via the ACA. It is important to note, however, that the first
of these opinions was ruled upon in the context of a political subdivision
defendant entitled to a post-trial “setoff” of collateral
benefits under Revised Code Section 2744.05(B)(1), and thus clearly distinguishable
in the vast majority of cases involving private defendants.
Jones v. MetroHealth Med. Ctr., a trial court opinion issued in a birth trauma case, the trial court found
that the damages awarded for the plaintiff’s life care plan was
to be limited to the “cost of care under the Affordable Care Act”
for the eight-year period before the plaintiff was to become Medicare
eligible. In doing so, the damages for life care plan categories except
transportation, home care, and housing were limited to $116,000, which
represented the $8,000.00 maximum annual premium and $6,500.00 annual
out-of-pocket limit established by ACA regulations for the duration of
this time period. The Eighth District Court of Appeals recently upheld this reasoning and
decision, despite reversing and remanding to prevent damage amounts attributable
to lost wages from being factored into the reduction.
Jones, however, was an action against a political subdivision, not a private
sector defendant, and the opinion at issue was rendered following a post-trial
hearing conducted pursuant to R.C. § 2744.05(B)(1). Section 2744.05(B)(1)
provides that collateral benefits from any source are to “be disclosed
to the court, and the amount of the benefits shall be deducted from any
award against a political subdivision recovered by that claimant.”
As pointed out in the
Jones appellate ruling and in the Ohio Supreme Court decision in
Buchman v. Board of Education, this setoff can only apply to benefits corresponding with a specific loss
included in the damages awarded by the trier of fact. As such, even in
those cases where a defendant is entitled to a statutory setoff for future
benefits, ACA-related evidence clearly cannot be introduced at trial,
but can only be introduced at a post-trial setoff hearing, and then only
if the defendant can show a clear correlation between future damages reflected
in the verdict and benefits that a plaintiff can reasonably be expected
to receive through future coverage.
Jones clearly can be limited to statutory setoff cases, at least one Ohio trial
court has held that the existence of the ACA and, by extension, the availability
of insurance coverage, cannot be kept from the jury. In
Christy v. Humility of Mary Health, the plaintiff filed a motion
in limine to prohibit any evidence or argument pertaining to benefits available
via Medicaid and/or coverage available through the ACA. Although the
Christy Court found that references to Medicaid coverage were barred by the collateral
source rule contained within Revised Code 2323.41, it nonetheless found that the ACA was the “law of the land”
and refused to grant the plaintiff’s motion in that regard.
Christy ruling appears to be problematic, the language of the order fails to provide
any explanation as to how a defendant could properly admit such evidence
without running afoul of the same collateral source rule it applied to
Medicaid, nor does it provide any guidance as to how the foundation for
ACA evidence can be established. At least three other trial court opinions
involving Ohio law directly contradict the Trumbull County ruling. In
Rogge v. Estes Express Lines, a trucking case that resulted in severe injuries to the plaintiff including
the loss of both legs, Judge Carr of the Northern District of Ohio granted a motion
in limine as to the very same kind of evidence at issue in
Christy. In refusing to permit a damages expert to testify “about possible
payments by private insurers if the plaintiff purchases insurance under
the Affordable Care Act,” the Court noted the speculative nature
of testimony, especially considering the fact that the plaintiff’s
accident-related injuries were covered by the Ohio Bureau of Workers Compensation
and it was not “reasonably likely” that ACA coverage would
be purchased. Furthermore, the court went on to state that “even
if the plaintiff were, for some reason, to purchase [ACA] insurance, it
would, in all likelihood, give the carrier a right of subrogation.” The evidence was thus subject to the collateral source statute and properly
excluded from consideration.
Similarly, the Butler County Court of Common Pleas was faced with a motion
in limine concerning ACA evidence in a birth-injury case in
Shiflett v. Troche. In refusing to permit evidence or argument regarding the potential for
this future coverage, the
Shiflett Court found that “[t]he ACA is a collateral source that is wholly
unrelated to the tortfeasor,” and also that “[a]ny testimony
that [the plaintiff] would or could receive health insurance through the
ACA is speculation and inadmissible at trial.”
McLeod v. St. Rita’s Med. Ctr., et al., the Allen County Court of Common Pleas was presented with similar arguments.
In its ruling, the
McLeod Court noted that “evidence of benefits payable to plaintiff in the
future, if they can be determined with a reasonable degree of certainty,
should be included as a type of evidence that is the subject of the collateral
source statutes.” Even when assuming the defense’s questionable
argument that “there is no right of subrogation under the Affordable
Care Act” in its decision, the court nonetheless ruled that such
evidence was inadmissible as “prejudicial and not relevant,”
as it was speculative that the plaintiff would be covered under the ACA
in the future given the potential for continued Medicaid coverage and/or
private insurance with a contractual right of subrogation. Considering that rulings on the admissibility of the ACA can often have
enormous effects on case valuation, pre-trial motions
in limine on the issue will continue to be common place in claims involving permanent
injuries for the foreseeable future. Under the current state of Ohio law,
however, a litany of arguments exist that should prevent defendants from
reaping the benefits of the ACA at the expense of injured plaintiffs and
third-party health insurers in this manner.
III. ACA Premiums and Out-of Pocket Caps Are Not Relevant To Determining
The Reasonable Value of Medical Services.
Ohio law has long provided that the “reasonable value of medical
services” is a proper measure of economic damages in an injury action. As the Ohio Supreme Court has recently clarified in its decisions in
Moretz, "'[b]oth the original medical bill rendered and the amount accepted
as full payment are admissible to prove the reasonableness and necessity
of charges rendered for medical and hospital care.'"
There is no categorical rule requiring a court or jury to accept either
the “billed” or “paid” amounts; rather “[t]he
jury may decide that the reasonable value of medical care is the amount
originally billed, the amount the medical provider accepted as payment,
or some amount in between." However, evidence of yearly premiums or out-of-pocket costs under health
insurance plans made available through the ACA are neither amounts billed
by a provider, nor do they represent amounts that a provider accepted
as full payment for services rendered. As such, they are wholly irrelevant
to the issue of fact in common pleas actions against private defendants,
in that they bear no relation to the “reasonable value” of
future medical services that are reasonably certain to occur in any particular
case. At most, they reflect the amount it would cost to have some source
other than the tortfeasor (or the tortfeasor’s insurer) make payment
for the reasonable value of services rendered. Such amounts reflect only
that which would be required for tort defendants, by and through a judgment,
to pass the bulk of negligently-caused damages onto a collateral payor/source
via the ACA guaranteed issue provision. Under
Moretz, however, this is not a proper measure of damages.
The reasoning behind such a position would run contrary to public policy
as well. Indeed, if such a position was to be accepted, the “reasonable
value” of covered future medical services provided to an injured
plaintiff insured by Medicare would always be zero, and the “reasonable
value” of essential benefit medical treatment provided to any injured
plaintiff covered by a particular plan would be the same, regardless of
the extent of the injuries and treatments required, so long as annual
out-of-pocket maximums were reached. Neither the Ohio Supreme Court nor
the General Assembly has ever recognized such a novel theory of damages,
which would effectively re-write decades of Ohio common law. Such evidence
should thus be excluded under Evid. R. 402 in common pleas actions against
private defendants, as annual maximums do not relate to “any fact
that is of consequence to the determination of the action” in a
permanent injury case.
Aside from the annual premium and/or out-of-pocket maximum amounts, a strong
argument exists that evidence of “amounts payable” by future
ACA plan coverage should also be precluded under Evid. R. 403. While
Robinson and its progeny recognized that these amounts can be taken into consideration
in the determination of “reasonable value,” there is a far
greater risk of undue prejudice in situations concerning future damages. In
Moretz, the Ohio Supreme Court found that past “amounts payable”
could be introduced without expert testimony via Revised Code 2317.421
in medical bills and statements that reflect write-off information. When addressing future medical expenses, however, this
facie evidence and the statutory presumption of reasonableness is unavailable.
Any introduction of future “amounts payable” should thus require
a proper foundation and, likely, expert testimony as to the availability
of ACA plans in a plaintiff’s marketplace, the degree of certainty
to which ACA coverage would be obtained as compared to other potential
insurance, services covered by the particular plan(s) as compared to a
plaintiff’s life care plan requirements, reimbursement rates for
said services, the likelihood to which said reimbursement rates would
change and/or remain constant, the costs associated with obtaining such
Even though Ohio law has long recognized that insurance is irrelevant and
not be taken into account in injury cases, any ruling permitting the introduction of future “amounts payable”
would seemingly require a trial-within-a-trial focused entirely on the
subject. Under Evid.R. 411, evidence of liability insurance is inadmissible
in tort actions as it has no probative value as to liability or damages,
and its introduction at trial can lead to juror confusion. In auto cases,
the fact that liability coverage is mandated by statute, i.e. “the
law of the land,” does nothing to change this conclusion. Nor should the general rule be
altered by the individual mandate found in 26 U.S.C.A. §5000A(b)(1).
Even if a trial court were to conclude that ACA-related evidence has some
level of probative value as to the “reasonable value of medical
services,” the potential that a jury will be misled by its introduction
also be taken into account. Admitting testimony as the availability of
policies in the marketplace, premiums, annual out-of-pocket maximums,
life care services covered as “essential health benefits,”
etc., invites a considerable risk of undue prejudice and confusion, and
trial courts should thus deem it inadmissible under Evid. R. 403 as well.
IV. Evidence of ACA Coverage Violates The Collateral Source Rule
The continued viability of the collateral source rule also provides a strong
barrier to any theory that the ACA can act to decrease or cap future award
damages. Arguments have been presented suggesting that the rule is “out
of sync” with the current health care landscape or that the individual
mandate should negate its application. Revised Code Sections 2315.20 and 2323.41 nonetheless continue to expressly
provide that evidence of amounts payable for damages are inadmissible
“if the source of collateral benefits has a mandatory self-effectuating
federal right of subrogation, a contractual right of subrogation, or a
statutory right of subrogation.”
For years, the vast majority of health insurance plans have contained provisions
providing for a contractual and/or statutory right of subrogation as to
medical payments for which a third-party tortfeasor is liable. In recent
cases tort defendants have often relied upon the fact that, unlike Medicare,
“the right of subrogation is not granted to insurers under the ACA.” It does not follow, however, that subrogation and/or reimbursement provisions
contained in policies are forbidden by the language of the law. The ACA
does nothing to curtail the practice of including subrogation and/or reimbursement
provisions in the language of a marketplace plan. Thus the “contractual”
right of subrogation contemplated in Ohio’s collateral source statute
can still be implicated in ACA coverage situations despite the lack of
a statutory or “self-effectuating” right of subrogation contained
within the law.
Given the presence of a contractual right of subrogation, any defense arguments
that a plaintiff is likely to receive a “windfall” or “double
recovery” of future damages due to the ACA would appear highly speculative,
at best. Limiting awards in such a manner when a contractual subrogation
provision is present would instead subject plaintiffs to the risk of a
“double reduction” of these future amounts. This would lead
to a patently unfair result, and the plain language of Ohio’s collateral
source statutes should continue to bar the introduction of such evidence
in the aftermath of ACA.
V. Evidence of Future ACA Coverage Cannot Be Admitted Without A Proper
Even in scenarios where a trial court determines that evidence of ACA annual
maximums and/or future amounts payable pass muster under Evid. R 402 and
403 and the collateral source statutes, most cases will likely give rise
to strong arguments regarding the inability of a defendant to lay a proper
foundation for the admission of such evidence. The need for competent
expert testimony regarding the “reasonably certain” effects
on future damages that the ACA will produce, without running afoul of
the collateral source rule, would seem to be an almost insurmountable
burden in many scenarios. Relevant inquiries to challenge such testimony
could include: (1) whether ACA coverage is likely to come into play at
all given the possibility of alternative coverage; (2) the qualifications of the proffered expert and his/her knowledge base concerning the ACA insurance marketplace, benefits
provided and language contained in specific available policies; (3) the
“reasonable certainty” with which it can be stated that annual
out-of-pocket maximums will remain constant; (4) the witness’s competence regarding the establishment of insurance
reimbursement rates (“amounts payable”) and the level of certainty
to which they can be predicted; (5) whether specific elements of care
in a plaintiff’s life care plan can be meaningfully correlated with
specific “essential health benefits,” as vaguely defined by
the ACA, and whether the defendant can establish that particular aspects
of the life care plan will be fully covered by any particular plan available
from the marketplace; and (6) whether the services specified in the life
care plan will be available “in-network” under a particular
policy, or whether they will constitute “out of network” costs
that are not subject to the ACA’s out of pocket caps.
Of course, it could be argued that the existence and availability of ACA-guaranteed
coverage throughout the duration of a plaintiff’s life care plan
is inherently speculative in its own right. Although the
Christy Court rejected such an argument by declaring the ACA “the law of
the land,” any witness offered to testify on the matter could not
reasonably deny that there have been more than sixty attempts in Congress
to repeal the ACA since its enactment, and statements made over the course
of the last year suggesting that a repeal of the law is of high priority
and a central platform for various political candidates. As pointed out
by one trial court, “[p]redictions about the longevity of the ACA
and its impact on health care costs are much too uncertain, conflicting,
and partisan to aid the jury in calculating damages and would likely lead
to confusion of the issues.”
Rather than acknowledging well-settled Ohio law as to the measure of medical
expense damages and the collateral source rule, defendants are increasingly
asking Ohio trial courts to change the rules so as to permit the ACA,
a law passed without any tort or “malpractice reform” included
therein, to further tilt the playing field in their favor. These efforts
will almost certainly continue and become more commonplace, and more arguments
will develop, until further guidance on the issue is provided by the Ohio
Supreme Court and appellate districts. For the time being, however, the
windfalls sought by defendants should not be considered permissible in
cases involving private defendants, and practitioners should be prepared
to face numerous arguments to ensure that this remains the case.
*This article was priginally published in Ohio Trial Magazine.
 Pub. L. No. 111-148, 124 Stat. 119 (2010)
See National Federation of Indep. Business v. Sebelius 132 S.Ct. 2566, 183 L.Ed.2d 450 (2012), at syllabus.
 These would include ambulatory patient services, emergency services, hospitalization,
maternity and newborn care, mental health and substance abuse disorder
services, prescription drugs, rehabilitative services and devices, lab
services, preventative care and chronic disease management, and pediatric
services including oral and vision care.
See 42 U.S.C.A. §18022 (2015).
See 42 U.S.C.A. §18022; 45 C.F.R. 147.108; 45 C.F.R. 147.150; 45 C.F.R. 147.126.
 26 U.S.C.A. §5000A(b)(1).
 26 U.S.C.A. §5000A(t)(1)(A)-(e).
See Roberti, “The Disappearing Provision: Medical Liability Reform Vanishes
from the Patient Protection and Affordable Care Act Despite State Court
Legislation and Policy Brief: Vol. 4: Iss. 2, Art. 5 (2012). Available at
See Congdon-Hohman, et al., “Life-care Awards in the Age of the Affordable
College of the Holy Cross, Dept. of Economics, Paper No. 14-06 (September 2014), available athttp://web.holycross.edu/RePEc/hcx/HC1406-Matheson-Congdon_ACAUpdate.pdf.
Wintermute v. Fairfield Med. Ctr., Fairfield C.P. No. 12-CV-1061 (Defs. Memo Contra Motion
in Limine filed Oct. 9, 2014).
Dohl v. Sunrise Mountainview Hosp. Inc., Nev. Dist. Ct. No. 14A698672, 2015 WL 1953074 (Apr. 20, 2015), *3;
Ng v. Ruehlrnann, Wash. King Cty. Sup. Ct. No. 13-2-36575-8 (Mar. 17, 2015);
Deeds v. Univ. of Penn. Med. Ctr., Pa. Sup. Ct. No. 755 EDA 2014, 110 A.3d 1009 (Jan 30, 2015);
Brown v. LTF Club Oper. Co., Inc., Nev. Dist. Ct. No. 12A672290, 2014 WL 5430159 (Sep. 15, 2014);
Beishline v. Berwick Hosp. Co., Pa. 26th Comm. Pl. No. 1553-CV-2011, 2014 WL 3558135 (May 1, 2014);
Halsne v. Avera Health,(U.S. Minn.), No. 12-cv-2409, 2014 WL 1153504 (Mar. 21, 2014);
Lee v. Willis Enterprises, Wash. Super. C.P. No. 122008911, 2014 WL 1796954 (Feb. 25, 2014).
See Donaldson v. Advantage Health Physicians, Mich. Kent Cty. Cir. Ct. No 11-09181-NH (2015);
Brewington v. United States, U.S. Cal. Cent. No. 13-07672-DMG, 2015 U.S. Dist. LEXIS 97720 (July 24, 2015);
Sivels v. Memorial Med. Ctr., Ill Sangamon Cty. Cir. Ct. No. 2011-L-000184 (Apr. 2, 2015);
KuhlMann & Perkins v. Johnson & Johnson Health Care Sys., Cal Alameda Cty. Cir. Ct. No RG13 675753 (Oct. 22, 2015);
Balleras v. Kapiolani, Haw. 1st Cir. Ct. No. 1CC07-1-00077 (June 27, 2013);
Daniels v. Havasu Reg. Med. Ctr., AZ Maricopa Cty. Sup. Ct. No. CV2011094814, 2014 WL10298104 (March 5, 2014).
Jones v. MetroHealth Med. Ctr., Cuyahoga C.P. No CV-11-757131, 2015 Ohio Misc. LEXIS 21152.
Jones v. MetroHealth Med. Ctr., 8th Dist. Cuyahoga No. 102916, 2016-Ohio-4858. ¶¶55-58.
 72 Ohio St.3d 260, 652 N.E. 952 (1995).
 A similar result could also occur in cases brought against state agencies
and universities in the Court of Claims, as both R.C. 2743.02 (D) (governing
claims against the state) and R.C. 3345.40 (B)(2) (governing claims against
state universities) require reductions for collateral benefits as well.
Christy v. Humility of Mary Health, Trumbull C.P. No. 2013CV01598, 2015 Ohio Misc. LEXIS 21369 (May 4, 2015).
 “In any civil action upon a medical, dental, optometric, or chiropractic
claim, the defendant may introduce evidence of any amount payable as a
benefit to the plaintiff as a result of the damages that result from an
injury, death, or loss to person or property that is the subject of the
claim, except if the source of collateral benefits has a mandatory self-effectuating
federal right of subrogation, a contractual right of subrogation, or a
statutory right of subrogation.” In non-medical tort cases, the
same statutory collateral source rule is found in Revised Code 2315.20.
Rogge v. Estes Express Lines (N.D. Ohio), No. 3:13CV1227, 2014 U.S. Dist. LEXIS 159839 (Nov. 10, 2014).
Shiflett v. Troche, Butler C.P. No. 2013-05-1646 (Apr. 13, 2015).
McLeod v. St. Rita’s Med. Ctr., et al., Allen C.P. No. CV2013-0398 (Nov. 12, 2015)
See Moretz v. Muakkassa, 137 Ohio St.3d 171, 2013-Ohio-4656, ¶90-91; citing
De Tunno v. Shull, 166 Ohio St. 365, 377 (1957).
Jacques v. Manton, 125 Ohio St.3d 342, 2010-Ohio-1838, ¶15; quoting
Robinson v. Bates, 112 Ohio St.3d 17, 2006-Ohio-6263, ¶17;
see also Jacques v. Manton, 125 Ohio St.3d 342, 2010-Ohio-1838.
Moretz, 2013-Ohio-4656 at ¶92.
See OSBA Jury Instructions, Tort Law II(A) “Insurance in Evidence.”
See Christy v. Humility of Mary Health, Trumbull C.P. No. 2013CV01598, 2015 Ohio Misc. LEXIS 21369 (May 4, 2015).
Laser, et al. v. MedCentral Health System, et al., Richland C.P. No. 14CV1029 (Defs. Motion
in Limine filed Apr. 4, 2016);
Wintermute v. Fairfield Med. Ctr., Fairfield C.P. No. 12-CV-1061 (Defs. Memo Contra Motion
in Limine filed Oct. 9, 2014).
See Congdon-Hohman, et al.,
supra at p. 7;
see also McLeod v. St. Rita’s Med. Ctr., et al., Allen C.P. No. CV2013-0398 (Nov. 12, 2015).
 It is not surprising that upon close inspection of a policy relied upon
by a defense expert in a recent Richland County birth injury case, the
“Gold Pathway X PPO 1250” ACA marketplace plan offered by
Anthem Blue Cross Blue Shield contained a contractual subrogation provision
similar to those often seen in ERISA or private health insurance scenarios.
Laser, et al. v. MedCentral Health Sys., et al., Richland C.P. No. 14CV1029 (Pl’s Brief in Opposition to Defs. Motion
in Limine filed Apr. 13, 2016). The defendant in that case attempted to argue that
the contractual subrogation provision was rendered unenforceable by the
fact that the ACA prohibits lifetime coverage caps. Although the issue
of whether or not such a provision would be enforceable could perhaps
be called in question, it would seem far-fetched for a trial court to
permit a defendant to speculate as to the applicability of coverage provisions
in an ACA insurance policy while at the same disregarding the application
of subrogation language found in the same document.
See Rogge, 2014 U.S. Dist. LEXIS 159839 (BWC coverage available for accident-related
McLeod v. St. Rita’s Med. Ctr., et al., Allen C.P. No. CV2013-0398 (Nov. 12, 2015) (Medicaid available).
 In at least one recent case, a defendant has attempted to introduce evidence
of the ACA’s effects on a life care plan via the testimony of a
nurse life care planner, despite her acknowledgement that she lacked independent
knowledge as to the ACA and its pertinent provisions, the insurance marketplace,
the policy relied upon, etc., and that her opinions in this regard were
based solely on an analysis letter provided to her by an “insurance
expert” that had not been identified in the case.
Laser et. al. v. MedCentral Health, et al., Richland C.P. 14CV1029 (Pls. Motion
in Limine filed Apr. 13, 2016).
 The out-of-pocket limit for 2014 ACA marketplace plans for individuals
was $6,360 and $12,700 for families. As of 2016, these limits have increased
to $6,850 and $13,700, respectively.
See Jackson v. Washington Hosp. Corp., D.C. Sup. Ct. No. 2012 CA 003612 M (October 23, 2015).