Empire Healthchoice Assurance, Inc. v. McVeigh
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Full Opinion
delivered the opinion of the Court.
The Federal Employees Health Benefits Act of 1959 (FEHBA), 5 U. S. C. §8901 et seq. (2000 ed. and Supp. III), establishes a comprehensive program of health insurance for federal employees. The Act authorizes the Office of Personnel Management (OPM) to contract with private carriers to offer federal employees an array of health-care plans. See § 8902(a) (2000 ed.). Largest of the plans for which OPM has contracted, annually since 1960, is the Blue Cross Blue Shield Service Benefit Plan (Plan), administered by local Blue Cross Blue Shield companies. This case concerns the proper forum for reimbursement claims when a Plan beneficiary, injured in an accident, whose medical bills have been paid by the Plan administrator, recovers damages (unaided by the carrier-administrator) in a state-court tort action against a third party alleged to have caused the accident.
The instant case originated when the administrator of a Plan beneficiaryâs estate pursued tort litigation in state court against parties alleged to have caused the beneficiaryâs injuries. The carrier had notice of the state-court action, but took no part in it. When the tort action terminated in a settlement, the carrier filed suit in federal court seeking reimbursement of the full amount it had paid for the beneficiaryâs medical care. The question presented is whether 28 U. S. C. § 1331 (authorizing jurisdiction over âcivil actions arising under the ... laws ... of the United Statesâ) encompasses the carrierâs action. We hold it does not.
FEHBA itself provides for federal-court jurisdiction only in actions against the United States. Congress could decide and provide that reimbursement claims of the kind here involved warrant the exercise of federal-court jurisdiction. But claims of this genre, seeking recovery from the proceeds of state-court litigation, are the sort ordinarily resolved in state courts. Federal courts should await a clear signal from Congress before treating such auxiliary claims as âarising underâ the laws of the United States.
I
FEHBA assigns to OPM responsibility for negotiating and regulating health-benefits plans for federal employees. See
The contract between OPM and the BCBSA provides: âBy enrolling or accepting services under this contract, [enrollees and their eligible dependents] are obligated to all terms, conditions, and provisions of this contract.â App. 90. An appended brochure sets out the benefits the carrier shall provide, see id., at 89, and the carrierâs subrogation and recovery rights, see id., at 100. Each enrollee, as FEHBA directs, receives a statement of benefits conveying information about the Planâs coverage and conditions. 5 U. S. C. § 8907(b). Concerning reimbursement and subrogation, matters FEHBA itself does not address, the BCBSA Planâs statement of benefits reads in part:
âIf another person or entity . . . causes you to suffer an injury or illness, and if we pay benefits for that injury or illness, you must agree to the following:
âAll recoveries you obtain (whether by lawsuit, settlement, or otherwise), no matter how described or designated, must be used to reimburse us in full for benefits we paid. Our share of any recovery extends only to the amount of benefits we have paid or will pay to you or, if applicable, to your heirs, administrators, successors, or assignees.
*685 âIf you do not seek damages for your illness or injury, you must permit us to initiate recovery on your behalf (including the right to bring suit in your name). This is called subrogation.
âIf we pursue a recovery of the benefits we have paid, you must cooperate in doing what is reasonably necessary to assist us. You must not take any action that may prejudice our rights to recover.â App. 165.1
If the participant does not voluntarily reimburse the Plan, the contract requires the carrier to make a âreasonable effort to seek recovery of amounts ... it is entitled to recover in cases .. . brought to its attention.â Id., at 95, 125. Pursuant to the OPM-BCBSA master contract, reimbursements obtained by the carrier must be returned to the Treasury Fund. See id., at 92, 118-119.
FEHBA contains a preemption provision, which originally provided:
âThe provisions of any contract under this chapter which relate to the nature or extent of coverage or benefits (including payments with respect to benefits) shall supersede and preempt any State or local law, or any regulation issued thereunder, which relates to health insurance or plans to the extent that such law or regulation is inconsistent with such contractual provisions.â 5 U. S. C. § 8902(m)(1) (1994 ed.).
FEHBA contains but one provision addressed to federal-court jurisdiction. That provision vests in federal district courts âoriginal jurisdiction, concurrent with the United States Court of Federal Claims, of a civil action or claim against the United States founded on this chapter.â §8912. The purpose of this provision â evident from its reference to the Court of Federal Claims â was to carve out an exception to the statutory rule that claims brought against the United States and exceeding $10,000 must originate in the Court of Federal Claims. See 28 U. S. C. § 1346(a)(2) (establishing district courtsâ jurisdiction, concurrent with the Court of Federal Claims, over claims against the United States that do not exceed $10,000); see also S. Rep. No. 1654, 83d Cong., 2d Sess., 4-5 (1954) (commenting, with respect to an identical provision in the Federal Employeesâ Group Life Insurance Act, 5 U. S. C. § 8715, that the provision âwould extend the jurisdiction of United States district courts above the $10,000 limitation now in effectâ).
Under a 1995 OPM regulation, suits contesting final OPM action denying health benefits âmust be brought against OPM and not against the carrier or carrierâs subcontractors.â 5 CFR § 890.107(c) (2005). While this regulation channels
II
Petitioner Empire HealthChoice Assurance, Inc., doing business as Empire Blue Cross Blue Shield (Empire), is the entity that administers the BCBSA Plan as it applies to federal employees in New York State. Respondent Denise Finn McVeigh (McVeigh) is the administrator of the estate of Joseph E. McVeigh (Decedent), a former enrollee in the Plan. The Decedent was injured in an accident in 1997. Plan payments for the medical care he received between 1997 and his death in 2001 amounted to $157,309. McVeigh, on behalf of herself, the Decedent, and a minor child, commenced tort litigation in state court against parties alleged to have caused Decedentâs injuries. On learning that the parties to the state-court litigation had agreed to settle the tort claims, Empire sought to recover the $157,309 it had paid out for the Decedentâs medical care.
Empire then filed suit in the United States District Court for the Southern District of New York, alleging that Mc
A divided panel of the Court of Appeals for the Second Circuit affirmed, holding that âEmpireâs clai[m] arise[s] under state law.â Id., at 150. FEHBAâs text, the court observed, contains no authorization for carriers âto vindicate [in federal court] their rights [against enrollees] under FEHBAauthorized contractsâ; therefore, the court concluded, âfederal jurisdiction exists over this dispute only if federal common law governs Empireâs claims.â Id., at 140. Quoting Boyle v. United Technologies Corp., 487 U. S. 500, 507, 508 (1988), the appeals court stated that courts may create federal common law only when âthe operation of state law would (1) âsignificantly] conflictâ with (2) âuniquely federal interest^].â â 396 F. 3d, at 140.
Empire maintained that its contract-derived claim against McVeigh implicated ââuniquely federal interest^],ââ because (1) reimbursement directly affects the United States Treasury and the cost of providing health benefits to federal employees; and (2) Congress had expressed its interest in maintaining uniformity among the States on matters relating to federal health-plan benefits. Id., at 141. The court acknowledged that the case involved distinctly federal interests, but found that Empire had not identified âspecific ways in which the operation of state contract law, or indeed of
The Court of Appeals next considered and rejected Empireâs argument that FEHBAâs preemption provision, 5 U. S. C. §8902(m)(1), independently conferred federal jurisdiction. 396 F. 3d, at 145-149. That provision, the court observed, is âa limited preemption clause that the instant dispute does not trigger.â Id., at 145. Unlike §8912, which âauthorizes] federal jurisdiction over FEHBA-related . . . claims âagainst the United States,ââ the court noted, § 8902(m)(1) âmakes no reference to a federal right of action [in] or to federal jurisdiction [over]â the contract-derived reimbursement claim here at issue. 396 F. 3d, at 145, and n. 7.
Judge Raggi dissented. Id., at 151. In her view, FEHBAâs preemption provision, § 8902(m)(1), as amended in 1998, both calls for the application of uniform federal common law to terms in a FEHBA plan and establishes federal jurisdiction over Empireâs complaint.
We granted certiorari, 546 U. S. 1085 (2005), to resolve a conflict among lower federal courts concerning the proper forum for claims of the kind Empire asserts. Compare Blue Cross & Blue Shield of Ill. v. Cruz, 396 F. 3d 793, 799-800 (CA7 2005) (upholding federal-jurisdiction), Caudill v. Blue Cross & Blue Shield of N. C., 999 F. 2d 74, 77 (CA4 1993) (same), and Medcenters Health Care v. Ochs, 854 F. Supp. 589, 593, and n. 3 (Minn. 1993) (same), affâd, 26 F. 3d 865 (CA8 1994), with Goepel v. National Postal Mail Handlers Union, 36 F. 3d 306, 314-315 (CA3 1994) (rejecting federal jurisdiction), and 396 F. 3d, at 139 (decision below) (same).
Ill
Title 28 U. S. C. § 1331 vests in federal district courts âoriginal jurisdictionâ over âall civil actions arising under the Constitution, laws, or treaties of the United States.â A
Empire and the United States, as amicus curiae, present two principal arguments in support of federal-question jurisdiction. Emphasizing our opinion in Jackson Transit Authority v. Transit Union, 457 U. S. 15, 22 (1982), and cases cited therein, they urge that Empireâs complaint raises a federal claim because it seeks to vindicate a contractual right contemplated by a federal statute, a right that Congress intended to be federal in nature. See Brief for Petitioner 14-31; Brief for United States 12-23. FEHBAâs preemption provision, Empire and the United States contend, demonstrates Congressâ intent in this regard. The United States argues, alternatively, that there is federal jurisdiction here, as demonstrated by our recent decision in Grable & Sons Metal Products, Inc. v. Darue Engineering & Mfg., 545 U. S. 308 (2005), because âfederal law is a necessary element of [Empireâs] claim.â Brief for United States 25; accord Brief for Petitioner 41, n. 5. We address these arguments in turn. But first, we respond to the dissentâs view that Empire and the United States have engaged in unnecessary labor, for Clearfield Trust Co. v. United States, 318 U. S. 363 (1943), provides âa basis for federal jurisdictionâ in this case. Post, at 702.
A
Clearfield is indeed a pathmarking precedent on the authority of federal courts to fashion uniform federal common law on issues of national concern. See Friendly, In Praise of Erie â and of the New Federal Common Law, 39 N. Y. U. L. Rev. 383, 409-410 (1964). But the dissent is mistaken in supposing that the Clearfield doctrine covers this case.
In post-Clearfield decisions, and with the benefit of enlightened commentary, see, e. g., Friendly, supra, at 410, the Court has âmade clear that uniform federal law need not be applied to all questions in federal government litigation, even in cases involving government contracts,â R. Fallon, D. Meltzer, & D. Shapiro, Hart and Wechslerâs The Federal Courts and the Federal System 700 (5th ed. 2003) (hereinafter Hart and Wechsler).
Later, in Boyle, the Court telescoped the appropriate inquiry, focusing it on the straightforward question whether the relevant federal interest warrants displacement of state law. See 487 U. S., at 507, n. 3. Referring simply to âthe displacement of state law,â the Court recognized that prior cases had treated discretely (1) the competence of federal courts to formulate a federal rule of decision, and (2) the appropriateness of declaring a federal rule rather than borrowing, incorporating, or adopting state law in point. The Court preferred âthe more modest terminology,â questioning whether âthe distinction between displacement of state law and displacement of federal lawâs incorporation of state law ever makes a practical difference.â Ibid. Boyle made two further observations here significant. First, Boyle explained, the involvement of âan area of uniquely federal interest . . . establishes a necessary, not a sufficient, condition for the displacement of state law.â Id., at 507. Second, in some cases, an âentire body of state lawâ may conflict with the federal interest and therefore require replacement. Id., at 508. But in others, the conflict is confined, and âonly particular elements of state law are superseded.â Ibid.
The dissent describes this case as pervasively federal, post, at 702, and âthe provisions . . . here [as] just a few scattered islands in a sea of federal contractual provisions,â post, at 709. But there is nothing âscatteredâ about the provisions on reimbursement and subrogation in the OPMBCBSA master contract. See supra, at 684-685. Those provisions are linked together and depend upon a recovery from a third party under terms and conditions ordinarily governed by state law. See infra, at 698.
B
We take up next Empireâs Jackson Transit-derived argument, which is, essentially, a more tailored variation of the theme sounded in the dissent. It is undisputed that Congress has not expressly created a federal right of action enabling insurance carriers like Empire to sue health-care beneficiaries in federal court to enforce reimbursement rights under contracts contemplated by FEHBA. Empire and the United States nevertheless argue that, under our 1982 opinion in Jackson Transit, Empireâs claim for reimbursement, arising under the contract between OPM and the BCBSA, âstates a federal claimâ because Congress intended all rights and duties stemming from that contract to be âfederal in nature.â Brief for United States as Amicus Curiae 12; see Brief for Petitioner 18-29. We are not persuaded by this argument.
The reliance placed by Empire and the United States on Jackson Transit is surprising, for that decision held there was no federal jurisdiction over the claim in suit. The federal statute there involved, § 13(c) of the Urban Mass Transportation Act of 1964 (UMTA), 78 Stat. 307 (then codified at 49 U. S. C. § 1609(c) (1976 ed.)), conditioned a governmental unitâs receipt of federal funds to acquire a privately owned transit company on preservation of collective-bargaining rights enjoyed by the acquired companyâs employees. 457 U. S., at 17-18. The city of Jackson, Tennessee, with federal financial assistance, acquired a failing private bus company
For several years thereafter, the transit authority covered its unionized workers in a series of collective-bargaining agreements. Eventually, however, the Authority notified the union that it would no longer adhere to collective-bargaining undertakings. Id., at 19. The union commenced suit in federal court alleging breach of the § 13(c) agreement and of the latest collective-bargaining agreement. Ibid. This Court determined that the case did not arise under federal law, but was instead âgoverned by state law [to be] applied in state cour[t].â Id., at 29.
The Court acknowledged in Jackson Transit that âon several occasions [we had] determined that a plaintiff stated a federal claim when he sued to vindicate contractual rights set forth by federal statutes, [even though] the relevant statutes lacked express provisions creating federal causes of action.â Id., at 22 (emphasis added) (citing Machinists v. Central Airlines, Inc., 372 U. S. 682 (1963) (union had a federal right of action to enforce an airline-adjustment-board award included in a collective-bargaining contract pursuant to a provision of the Railway Labor Act); Norfolk & Western R. Co. v. Nemitz, 404 U. S. 37 (1971) (railroadâs employees stated federal claims when they sought to enforce assurances made by the railroad to secure Interstate Commerce Commission approval of a consolidation under a provision of the Interstate Commerce Act); Transamerica Mortgage Advisors, Inc. v. Lewis, 444 U. S. 11, 18-19 (1979) (permitting federal suit for rescission of a contract declared void by a provision of the Investment Advisers Act of 1940)). But prior decisions, we said, âd[id] not dictate the result in [the Jackson Transit] case,â for in each case, âthe critical factorâ in determining âthe scope of
âIn some ways,â the Jackson Transit Court said, the UMTA âseem[ed] to make § 13(c) agreements and collective-bargaining contracts creatures of federal law.â Id., at 23. In this regard, the Court noted, § 13(c)
âdemanded] âfair and equitable arrangementsâ as prerequisites for federal aid; it required] the approval of the Secretary of Labor for those arrangements; it specified] five different varieties of protective provisions that must be included among the § 13(c) arrangements; and it expressly incorporated] the protective arrangements into the grant contract between the recipient and the Federal Government.â Ibid. (quoting 49 U. S. C. § 1609(c) (1976 ed.)).
But there were countervailing considerations. The Court observed that âlabor relations between local governments and their employees are the subject of a longstanding statutory exemption from the National Labor Relations Act.â 457 U. S., at 23. âSection 13(c),â the Court continued, âevinced] no congressional intent to upset the decision in the [NLRA] to permit state law to govern the relationships between local governmental entities and the unions representing their employees.â Id., at 23-24. Legislative history was corroborative. âA consistent theme,â the Court found, â[ran] throughout the consideration of § 13(c): Congress intended that labor relations between transit workers and local governments would be controlled by state law.â Id., at 24. We therefore held that the union had come to the wrong forum. Congress had indeed provided for § 13(c) agreements and collective-bargaining contracts stemming from them, but in the Courtâs judgment, the unionâs proper recourse for enforcement of those contracts was a suit in state court.
FEHBAâs jurisdictional provision, 5 U. S. C. § 8912, opens the federal district-court door to civil actions âagainst the United States.â See supra, at 686. OPMâs regulation, 5 CFR §890.107(c) (2005), instructs enrollees who seek to challenge benefit denials to proceed in court against OPM âand not against the carrier or carrierâs subcontractors.â See ibid. Read together, these prescriptions âensur[e] that suits brought by beneficiaries for denial of benefits will land in federal court.â 396 F. 3d, at 145, n. 7. Had Congress found it necessary or proper to extend federal jurisdiction further,, in particular, to encompass contract-derived reimbursement claims between carriers and insured workers, it would have been easy enough for Congress to say so. Cf. 29 U. S. C. § 1132(a)(3) (authorizing suit in federal court âby a participant, beneficiary, or fiduciaryâ of a pension or health plan governed by ERISA to gain redress for violations of âthis subchapter or the terms of the planâ). We have no warrant to expand Congressâ jurisdictional grant âby judicial decree.â See Kokkonen v. Guardian Life Ins. Co. of America, 511 U. S. 375, 377 (1994).
Nor do we read 5 U. S. C. § 8902(m)(l), FEHBAâs preemption prescription, see supra, at 685-686, as a jurisdiction-conferring provision. That choice-of-law prescription is unusual in that it renders preemptive contract terms in health insurance plans, not provisions enacted by Congress. See 396 F. 3d, at 143-145; id., at 151 (Sack, J., concurring). A prescription of that unusual order warrants cautious interpretation.
Section 8902(m)(1) is a puzzling measure, open to more than one construction, and no prior decision seems to us precisely on point. Reading the reimbursement clause in the master OPM-BCBSA contract as a condition or limitation on âbenefitsâ received by a federal employee, the clause could be ranked among â[contract] terms ... relating] to ... coverage or benefitsâ and âpayments with respect to benefits,â thus falling within § 8902(m)(1)âs compass. See Brief for United States as Amicus Curiae 20; Reply Brief 8-9. On the other hand, a claim for reimbursement ordinarily arises long after âcoverageâ and âbenefitsâ questions have been resolved, and corresponding âpayments with respect to benefitsâ have been made to care providers or the insured. With that consideration in view, §8902(m)(1)âs words may be read to refer to contract terms relating to the beneficiaryâs entitlement (or lack thereof) to Plan payment for certain healthcare services he or she has received, and not to terms relating to the carrierâs postpayments right to reimbursement. See Brief for Julia Cruz as Amicus Curiae 10,11.
Section 8902(m)(1)âs text does not purport to render inoperative any and all state laws that in some way bear on federal employee-benefit plans. Cf. 29 U. S. C. § 1144(a) (portions of ERISA âsupersede any and all State laws insofar as they may now or hereafter relate to any employee benefit planâ). And, as just observed, see supra, at 697, given that §8902(m)(1) declares no federal law preemptive, but instead, terms of an OPM-BCBSA negotiated contract, a modest reading of the provision is in order. Furthermore, a reimbursement right of the kind Empire here asserts stems from a personal-injury recovery, and the claim underlying that recovery is plainly governed by state law. We are not prepared to say, based on the presentations made in this case, that under § 8902(m)(l), an OPM-BCBSA contract term would displace every condition state law places on that recovery.
As earlier observed, the BCBSA Planâs statement of benefits links together the carrierâs right to reimbursement from the insured and its right to subrogation. See supra, at 684-685. Empireâs subrogation right allows the carrier, once it has paid an insuredâs medical expenses, to recover directly from a third party responsible for the insuredâs injury or
In sum, the presentations before us fail to establish that §8902(m)(1) leaves no room for any state law potentially bearing on federal employee-benefit plans in general, or carrier-reimbursement claims in particular. Accordingly, we extract from §8902(m)(1) no prescription for federal-court jurisdiction.
C
We turn finally to the argument that Empireâs reimbursement claim, even if it does not qualify as a âcause of action created by federal law,â nevertheless arises under federal law for § 1331 purposes, because federal law is âa necessary element of the [carrierâs] claim for relief.â Brief for United States as Amicus Curiae 25-26 (quoting Grable, 545 U. S., at 312, and Jones v. R. R. Donnelley & Sons Co., 541 U. S. 369, 376 (2004)). This case, we are satisfied, does not fit within the special and small category in which the United States would place it. We first describe Grable, a recent decision that the United States identifies as exemplary,
Grable involved real property belonging to Grable & Sons Metal Products, Inc. (Grable), which the Internal Revenue Service (IRS) seized to satisfy a federal tax deficiency. 545 U. S., at 310. Grable received notice of the seizure by certified mail before the IRS sold the property to Darue Engineering & Manufacturing (Darue). Ibid. Five years later,
Darue removed the case to federal court. Alleging that Grableâs claim of title depended on the interpretation of a federal statutory provision, i. e., § 6335(a) of the Internal Revenue Code, Darue invoked federal-question jurisdiction under 28 U. S. C. § 1331. We affirmed lower court determinations that the removal was proper. âThe meaning of the federal tax provision,â we said, âis an important issue of federal law that sensibly belongs in a federal court.â 545 U. S., at 315. Whether Grable received notice adequate under § 6335(a), we observed, was âan essential element of [Grableâs] quiet title claimâ; indeed, âit appeared] to be the only . .. issue contested in the case.â Ibid.
This case is poles apart from Grable. Cf. Brief for United States as Amicus Curiae 27. The dispute there centered on the action of a federal agency (IRS) and its compatibility with a federal statute, the question qualified as âsubstantial,â and its resolution was both dispositive of the case and would be controlling in numerous other cases. See 545 U. S., at 313. Here, the reimbursement claim was triggered, not by the action of any federal department, agency, or service, but by the settlement of a personal-injury action launched in state court, see supra, at 687-688, and the bottom-line practical issue is the share of that settlement properly payable to Empire.
Grable presented a nearly âpure issue of law,â one âthat could be settled once and for all and thereafter would govern numerous tax sale cases.â Hart and Wechsler 65 (2005 Supp.). In contrast, Empireâs reimbursement claim, Me
The United States observes that a claim for reimbursement may also involve as an issue â[the] extent, if any, to which the reimbursement should take account of attorneyâs fees expended ... to obtain the tort recovery.â Brief as Amicus Curiae 29. Indeed it may. But it is hardly apparent why a proper âfederal-state balance,â see id., at 28, would place such a nonstatutory issue u