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
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
Submitted January 14, 2015
[Copyrighted Material Omitted]
Appeal from United States District Court for the Western District of Missouri - Jefferson City.
For 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: Jay Angoff, Ingrid Babri, Steven A. Skalet, Mehri & Skalet, Washington, DC; Abigail Coursolle, National Health Law Program, Los Angeles, CA; Jane Perkins, Martha Jane Perkins, National Health Law Program, Carrboro, NC.
For Director John M. Huff, in official capacity as Director of the Missouri Department of Insurance, Financial Institutions and Professional Registration, Defendant - Appellant: Jeremiah J. Morgan Sr., Deputy Solicitor, Attorney General's Office, Jefferson City, MO.
For Missouri Association of Insurance Agents, Amicus on Behalf of Appellant(s): James B. Deutsch, Marc Henry Ellinger, Thomas William Rynard, Blitz & Bardgett, Jefferson City, MO.
For Aarp, Amicus on Behalf of Appellee(s): Andrew Strickland, Jay E. Sushelsky, Senior Attorney, Aarp Foundation Litigation, Washington, DC.
For Sargent Shriver National Center on Poverty Law, Amicus on Behalf of Appellee(s): Margaret Stapleton, Sargent Shriver National Center on Poverty Law, Chicago, IL; Jay E. Sushelsky, Senior Attorney, Aarp Foundation Litigation, Washington, DC.
Before RILEY, Chief Judge, BEAM and COLLOTON, Circuit Judges.
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.
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. 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.
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]."  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), ...