In for a penny, in for a pound? The 26 states that are challenging the Affordable Care Act in a suit the Supreme Court will hear this year are tying the expansion of Medicaid included in the law to the individual mandate in their argument that the
law is unconstitutional.
Twenty-six states on Tuesday asked the Supreme Court to overturn the health care reform law’s mandatory state expansion of the Medicaid program, a sleeper issue in the health care reform lawsuit that could determine how much leverage the federal government has with the states on any issue.
The states, led by Florida, argue that the federal government can’t force them to expand the Medicaid program, which has operated as a partnership between the feds and the states, as part of the 2010 health reform law. They argue that the Medicaid expansion is possibly more coercive than the law’s individual mandate.
“While some individuals are exempt from the penalties designed to enforce the mandate, no state is exempt from the massive penalty—the loss of the entirety of funding under the single largest grant-in-aid programs for the states—and so Congress did not even contemplate the possibility of a state opting out of Medicaid,” attorney Paul Clement, who is representing the states, wrote in a brief to the court Tuesday.
The Medicaid argument, one of four issues in the health care law that the court has agreed to consider, is thought to be the toughest climb for the law’s challengers. But if the Supreme Court takes the states’ side, the ruling could limit whether the federal government can use money as an incentive for the states to act on any issue. [...]
The federal government argues that it is still a choice—even if it’s a difficult one. The Obama administration will have a chance to flesh out its argument in its own brief, which is due to the court by Feb. 10.
So far, the lower courts have agreed with the federal government. Both the Florida district court and the 11th Circuit Court that heard the 26 states’ lawsuit said the Medicaid expansion is valid.
The expansion of Medicaid is critical to the expansion of actual health care to the uninsured. The law requires that states expand Medicaid to enroll those uninsured with an income at or below 133 percent of the federal poverty level.