The Supreme Court will complete its review of President Obama’s health care law Wednesday by considering whether all of the law must fall if part of it is found unconstitutional, and whether the law’s proposed Medicaid expansion violates the federal-state partnership.
The Medicaid expansion decision might have the most lasting impact on the federal government’s ability to use its spending power to pressure state action. The Supreme Court has said there is a limit to what the government can force states to do in order to receive federal funds — a condition cannot be “so coercive as to pass the point at which pressure turns into compulsion.” But the court has yet to find a case where the federal government has gone too far.
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Justice Elena Kagan notes that people without health insurance raise the average premium of those who do pay for it, according to Congress, during the Supreme Court arguments on the health-care law.
The 26 states challenging the Patient Protection and Affordable Care Act say this is the case. They are protesting the law’s intent to open Medicaid to a far larger share of the poor. At least technically a voluntary program for states, Medicaid is jointly funded with state and federal dollars.
States argue it will cost them millions of dollars because of the number of poor that will access the program in order to meet the law’s requirement that almost all Americans must have health insurance by 2014.
The government responds that the law cannot be unduly coercive because the federal government will pay the full cost of covering the newly eligible individuals through 2016. Even in 2020 and thereafter, the federal government will pick up 90 percent of the tab. And states may drop out of Medicaid at any time.
But the states counter, in effect, that the government has them over a barrel. The Medicaid program has grown so large that it is impossible to forgo federal funds and still provide medical care for the poor, they say.
The federal government says an adverse ruling would cast doubt on one of its most fundamental powers, the power to spend money. And it could cause turmoil in a range of federal-state programs.
The severability question would come into play only if the court finds the health care law’s individual mandate unconstitutional.
One of the most sweeping and sprawling laws in recent memory, the Patient Protection and Affordable Care Act aims to vastly expand access to health insurance and curb spending on health-care, by fundamentally altering the architecture of the American health-care system: The law establishes new state-run marketplaces for the sale of private insurance, creates a new system of federal subsidies to help people purchase insurance, funds new fields of research, expands programs like Medicaid, reshapes the way Medicare pays for health care, and includes countless new rules on everything from how employers should treat breast-feeding mothers to how tanning salons should be taxed.
At issue is what should happen to all these measures in the event the Court rules the individual insurance mandate is unconstitutional.
In assessing severability, the court’s precedents say it should retain the parts of the law that are constitutionally valid, capable of functioning independently, and are consistent with Congress’s basic objectives in passing the statute.
The Medicaid expansion decision might have the most lasting impact on the federal government’s ability to use its spending power to pressure state action. The Supreme Court has said there is a limit to what the government can force states to do in order to receive federal funds — a condition cannot be “so coercive as to pass the point at which pressure turns into compulsion.” But the court has yet to find a case where the federal government has gone too far.
Video
Justice Elena Kagan notes that people without health insurance raise the average premium of those who do pay for it, according to Congress, during the Supreme Court arguments on the health-care law.
The 26 states challenging the Patient Protection and Affordable Care Act say this is the case. They are protesting the law’s intent to open Medicaid to a far larger share of the poor. At least technically a voluntary program for states, Medicaid is jointly funded with state and federal dollars.
States argue it will cost them millions of dollars because of the number of poor that will access the program in order to meet the law’s requirement that almost all Americans must have health insurance by 2014.
The government responds that the law cannot be unduly coercive because the federal government will pay the full cost of covering the newly eligible individuals through 2016. Even in 2020 and thereafter, the federal government will pick up 90 percent of the tab. And states may drop out of Medicaid at any time.
But the states counter, in effect, that the government has them over a barrel. The Medicaid program has grown so large that it is impossible to forgo federal funds and still provide medical care for the poor, they say.
The federal government says an adverse ruling would cast doubt on one of its most fundamental powers, the power to spend money. And it could cause turmoil in a range of federal-state programs.
The severability question would come into play only if the court finds the health care law’s individual mandate unconstitutional.
One of the most sweeping and sprawling laws in recent memory, the Patient Protection and Affordable Care Act aims to vastly expand access to health insurance and curb spending on health-care, by fundamentally altering the architecture of the American health-care system: The law establishes new state-run marketplaces for the sale of private insurance, creates a new system of federal subsidies to help people purchase insurance, funds new fields of research, expands programs like Medicaid, reshapes the way Medicare pays for health care, and includes countless new rules on everything from how employers should treat breast-feeding mothers to how tanning salons should be taxed.
At issue is what should happen to all these measures in the event the Court rules the individual insurance mandate is unconstitutional.
In assessing severability, the court’s precedents say it should retain the parts of the law that are constitutionally valid, capable of functioning independently, and are consistent with Congress’s basic objectives in passing the statute.
