Health
10:05 am
Fri June 29, 2012

WKU Legal Scholar Says High Court Ruling Means States Must "Opt In" for Increased Medicaid Funding

Much of the media attention regarding Thursday's Supreme Court ruling understandably focused on the upholding of the individual mandate. Less publicized was another part of the ruling--the part that said the health care law's expansion of Medicaid placed an unfair burden on states.

President Obama's Affordable Care Act told states they had to expand their Medicaid programs to a wider swath of poor Americans starting in 2014, or risk losing all of their existing Medicaid funding. The Attorneys General of 26 states, as part of their lawsuit against the health care act, said the threat violated previous agreements struck between the states and the federal government.

WKU Public Radio spoke to Dr. Patricia Minter, a constitutional law expert with the WKU History Department, about what the Supreme Court majority ruled regarding the Medicaid portion of the law:

“The majority ruled that the Medicaid expansion violates the Constitution by threatening the states with a loss of existing—and here you have to underline the word “existing”—by taking away existing Medicaid funding. So, that has become a vested right."

"Where do you get the power to do Medicaid? You get it under the general welfare clause of the Constitution."

"The point the Roberts court makes is that the Congress may enact cooperative state and federal spending programs. That’s called 'cooperative federalism.'"

"But it can only stand if the state voluntarily and knowingly accepts the terms of such a program. In other words, the state has to opt in. If they don’t opt in, you cannot take away what they already have, which is a vested right."

"So, the five justices in the majority agree that the extension of Medicaid to the states is Constitutional if—and it has to be an “if”—the states accept the terms. "

Chief Justice John Roberts surprised many observers by ruling with the majority that upheld the individual mandate portion of the law. What did he say in his opinion regarding the impropriety of the law's Medicaid funding element?

“To quote from the opinion: ‘When the Court confronts an unconstitutional statute, its endeavor must be to conserve, not destroy, legislation.’ So again, what Chief Justice Roberts and the majority are doing is demonstrating judicial restraint, by trying to find a way to uphold the overall law."

"And it’s Justices Roberts, Breyer, and Kagan who believe it’s unconstitutional to tell the states they lost what they’ve got if they don’t move ahead with the new plan. But if the state says “yes”, then the cooperative federalism of the expanded Medicaid funding will continue."

"The funding mechanism can be up to 100%. I think it’s unlikely that states will not opt in, because certainly Medicaid funding is a huge challenge that all states face.”