Power Grid Blog
AAPD Files Brief in Supreme Court Defending the Expansion of Medicaid in the Health Care Reform Act
February 21, 2012 | AAPD Power Grid Blog Team
By David Heymsfeld, AAPD Policy Advisor
AAPD has joined 78 other organizations, including many which advocate for the concerns of persons with disabilities, to file an amicus brief with the United States Supreme Court defending the provisions in the Health Care Reform Act (the Affordable Care Act) which expand the Medicaid program.
This is the second brief filed by AAPD in the Affordable Care Act cases: AAPD has already participated in an amicus brief on one issue, whether Congress has constitutional authority to require persons to purchase health insurance or pay a tax penalty. This brief involves a different issue; whether Congress can give financial support to State Medicaid programs, but insist that if the State accepts the funding the State must comply with federal requirements governing the program.
Ordinarily a person or organization can be a party to only one amicus brief in a Supreme Court case. But in the cases on the Affordable Care Act, the Supreme Court has divided the case into several issues for separate briefing, and persons can file separate amicus briefs on each of the issues.
Under the Medicaid law, Medicaid is not a single federal program. Rather the Medicaid law provides federal funding for individual State Medicaid programs, if the programs comply with various requirements. The requirements cover such issues as who must be made eligible, and what services must be covered. So far, all 50 States have chosen to develop a Medicaid program and accept federal funding.
The Affordable Care Act requires the States to extend Medicaid to all persons with income levels of up to 133% of the federal poverty level, as a condition of continuing to receive federal assistance. This will require a large number of persons to be added to the program. For the new persons brought into the program, the federal government will pay 100% of the costs from 2014 to 2016, and 90% after 2020.
The basic argument supporting the constitutionality of requiring states to expand their Medicaid programs is that even if the federal government would not have the power to impose an unfunded mandate requiring the States to expand their Medicaid programs, the federal government does have the power to encourage the States to do this by providing federal financial assistance. When the federal government makes money available to the States, there can be strings attached to the funding, and the States have a choice of meeting federal requirements or not accepting federal funding. Supporters of constitutionality point out that in Medicaid, if a State decides to reject any federal funding, the law does not place any obligation on the State to establish its own program to replace any part of Medicaid.
The argument made against the constitutionality of the Medicaid expansion is that because of the large federal funding of hundreds of billions of dollars a year now given to the States for Medicaid, it is unrealistic to say States have a choice of rejecting the expansion and giving up all the federal funding they now receive for Medicaid, Thus, it is argued, the federal government is using its spending power to “coerce” the States to substantially expand Medicaid,an expansion which Congress would have no power to require directly.
There have been no Supreme Court precedents which found it unconstitutional for the federal government to place strings on a large program of funding for the States, when rejection of the funding left the States free to decide to end participation in the program, without any legal obligation to replace the program. None of the Courts of Appeal cases reviewing the Affordable Care Act accepted the “coercion” argument, so it was surprising that the Supreme Court agreed to consider this issue.
This issue is of great importance to persons with disabilities. The Medicaid expansion will help many persons with disabilities. There are other programs which are valuable to persons with disabilites which also rely on the federal government placing requirements on federal assistance, including education programs for the developmentally disabled, and many other programs prohibiting discrimination against persons with disabilities in carrying out federally funded programs.
The Supreme Court is scheduled to hear oral arguments in the Affordable Care Act cases in January, and reach its decision in June.
