In the case of Maine Community Health Options v. United States, 2019, the Supreme Court ruled in favor of health insurance companies who argued that they were owed billions by the federal government under a provision of the Affordable Care Act (ACA). The ACA's 'risk corridors' program aimed to limit insurers’ risks during initial years when they had little information about their new customers’ health needs. It did this by providing payments from a pool funded by profitable plans to those with losses. However, Congress later passed spending bills limiting funds for these payments which led to massive shortfalls and several insurers went bankrupt as a result. Insurers sued for $12 billion unpaid amounts arguing that despite changes in funding provisions, statutory obligations remained unchanged. The court agreed stating that subsequent legislation could not relieve original promises made under ACA and held Federal Government accountable for payment.

In the dissenting opinion for Maine Community Health Options v. United States, Justice Alito argued that the majority's decision was a "massive bailout" for insurance companies and an unjustified burden on taxpayers. He contended that while Congress had initially promised to shield insurers from some of the risks they took by participating in health care exchanges, it later decided not to pay out these funds due to concerns about fiscal responsibility. According to Justice Alito, this change did not constitute a breach of contract because there was no binding agreement between insurers and the government; rather, it was simply a policy reversal within Congress' rights. Furthermore, he asserted that even if such an agreement existed, damages should be limited since insurers could have mitigated their losses by adjusting premiums or withdrawing from exchanges earlier.