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Court holds that states have choice whether to join medicaid expansion

by artappraiser 6/28/2012 - 1:06 pm

Clear, understandable explanation if you're looking for one:

By Kevin Russell, SCOTUS blog, July 28

The Court’s decision on the constitutionality of the Medicaid expansion is divided and complicated.  The bottom line is that: (1) Congress acted constitutionally in offering states funds to expand coverage to millions of new individuals; (2) So states can agree to expand coverage in exchange for those new funds; (3) If the state accepts the expansion funds, it must obey by the new rules and expand coverage; (4) but a state can refuse to participate in the expansion without losing all of its Medicaid funds; instead the state will have the option of continue the its current, unexpanded plan as is.

 The votes for this outcome are divided among several opinions [....]

Read the full article at http://www.scotusblog.com/2012/06/court-holds-that-states-have-choice-whether-to-join-medicaid-expansion/

So this may well become a high-profile issue in some states as selected (most? all?  Any Dem, or only GOP?) governors opt out of the Medicaid expansion provisions.

Will be interesting to see what the projections are on how many individuals the law's supporters want covered will not end up covered, depending on which states opt out on the Medicaid expansion provisions.  Clearly the federal government lost a large source of leverage for expanding coverage with this decision, notwithstanding the ways in which it represents a victory for its supporters.

by AmericanDreamer 6/28/2012 - 2:52 pm

Clearly the federal government lost a large source of leverage for expanding coverage with this decision

Yes, and the bigger the Medicare/Medicaid population, the more the feds can affect health care costs and health care practice.

I know people don't like to hear this argument, because it hurts the demonization narrative, but overall the private health insurance cos. really do basically follow the Fed lead on coverage, even using their codes for procedures and falling back on arguments like "well, Medicare/Medicaid doesn't cover this either."

by artappraiser 6/28/2012 - 3:09 pm (re: AmericanDreamer)

Confusing times 

Like asking for "papers please" and not being able to do anything afterwards, if ICE ignores you.

Then allow the unidentified detainee, to sue the State, for being detained for too long, because ICE ignored the investigative process. 

Clearly the federal government lost a large source of leverage

These justices of the SCOTUS are cowards.

Leaving to many unanswered questions and posing as a deliberative body.  What a joke they are. losing all respect.

by Resistance 6/28/2012 - 3:11 pm (re: AmericanDreamer)

Actually, whether one likes or dislikes the decision or particular parts of the ruling, and whether one likes or dislikes ACA, the Supreme Court did resolve a great deal with this decision.  They did not leave it unambiguous on the Medicaid expansion matter--states clearly will have authority not to participate in that part of ACA if that's what they decide to do.  So criticizing them for leaving too much up in the air with this decision does not seem valid to me.

by AmericanDreamer 6/28/2012 - 3:18 pm (re: Resistance)
I don't think the states will be able to refuse very long because it will have a blacklash and unintended problems in their state health care system.
by trkingmomoe 6/29/2012 - 2:53 am (re: AmericanDreamer)

Well, there were GOP Governors--Sanford in S. Carolina before he imploded--who made a big thing out of refusing the stimulus money at a time when unemployment was even higher in 2009.  And there wasn't even any constitutional question as to whether Congress could lawfully have provided that.  It's easy for me to see several Governors very publicly declining to expand thru Medicaid, using a similar tone to former Governor Sanford of "standing up" to the big bad federal government.  They probably figure most of the folks who would have gained coverage through that provision wouldn't vote for them anyway.  

by AmericanDreamer 6/29/2012 - 8:57 am (re: trkingmomoe)

"More Republican State Leaders Considering Opting Out of Medicaid Expansion", N.C.Aizenman and Sandhya Somashekhar, July 3 Washington Post online (July 4 print edition): http://www.washingtonpost.com/national/health-science/more-state-leaders-considering-opting-out-of-medicaid-expansion/2012/07/03/gJQADvMsLW_story.html?hpid=z1

by AmericanDreamer 7/4/2012 - 9:58 am (re: AmericanDreamer)

Link to state-by-state interactive map at Center for American Progress, showing which states are committed to Medicaid expansion, which have declined, and which are uncommitted: http://www.americanprogress.org/issues/2012/07/medicaid_expansion_map.html

by AmericanDreamer 7/5/2012 - 3:12 pm (re: AmericanDreamer)

Has the political blogosphere been freaking out over the wrong ruling?

The Medicaid ruling's ripple effect

By J Lester Feder and Darrell Samuelsohn, PoliticoPro, July 3, 2012

[....] It'll take many years — and many lawsuits — before the full effects of Roberts’s health care ruling are sorted out. Still, legal experts on both the right and the left agree that the door is now open for states to challenge everything from the Clean Air Act to No Child Left Behind and anti-discrimination protections [....]

by artappraiser 7/3/2012 - 2:30 pm

Do you mean different consequences of the ACA ruling than the ones that have been getting the attention?  When I read the comment I thought maybe there was a different SCOTUS decision you were referring to.

by AmericanDreamer 7/3/2012 - 2:35 pm (re: artappraiser)

Seems to me most blogging has been about the mandate/penalty/tax & commerce clause issue, as if that is the one that would be causing the most big problems down the road, and just shrugging at the Medicaid ruling. This article sure makes it sound like the Medicaid ruling is the one that is going to cause major problems for Federal law down the road.

by artappraiser 7/3/2012 - 4:21 pm (re: AmericanDreamer)

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