Our Views: A big ruling for states?

If the decision to uphold the national health-care law was a victory for President Barack Obama in the U.S. Supreme Court, the justices hardly made it a complete one.

Instead, with a ruling “less liberal than it looks,” according to one analyst, the expansion of Medicaid to provide health care for the poor was made more optional than intended by Congress in 2010 when it passed the new law.

Congress intended to force states to buy into a Medicaid expansion, by saying that if states did not go along they would lose their eligibility for the entire program. The high court called that too coercive of the states, and struck down that provision of the law.

Darrell M. West of The Brookings Institution called that part of the less-liberal parts of the decisions rendered by the court.

“This gives states the authority to resist national efforts to expand health insurance coverage for the uninsured,” West said. “With the dire fiscal straits of many states, many places will be unlikely to extend coverage and the result will be fewer uninsured will receive coverage than was expected when the legislation passed.” Louisiana is one of the states that has so far refused to buy into a Medicaid expansion, even though there are hundreds of thousands of lower-paid workers who don’t today have access to health insurance.

But will states use this new power? Other analysts said states will be enticed by the generous federal aid — 100 percent of the new costs covered in the first years, and 90 percent thereafter. That’s even better than the about 70 percent of Medicaid costs now covered for Louisiana, one of the poorer states with high numbers of uninsured.

The upshot of the ruling in terms of health insurance may become clearer over time. But at least one law professor argues that the ruling’s Medicaid provision will be good for lawyers.

“That truly breaks new ground,” Richard Fallon, a Harvard law professor, told The Washington Post. “It’s the first time since the 1930s that the Supreme Court has invalidated a federal spending statute that gives money to states and attaches strings.” He added: “A number of other federal spending programs that attach strings will now be attacked as coercive.” Once again, it’s not clear how many such programs will end up in litigation on this new principle. But clearly there has been a proliferation of laws with Congress seeking to push states to regulate particular activities — from highway rules to education standards and on and on.

It will be one of the legacies of the court headed by Chief Justice John Roberts that the court might be in the position of deciding what’s coercive and what’s reasonable.

Comments

1) Comment by stuckinthebr - 09/07/2012

An entire opinion piece on what the supreme court ruling "could mean for states", and "what governors might or might not do" which somehow omits the fact that Governor Jindal has publicly insisted that he will not take the money to expand Medicaid and cover over 300 thousand people who are under the poverty line yet do not currently qualify for Medicaid. And no reader is given basic information to properly understand what this expansion is, i.e. that the "expansion" covers people between 30% and 100% of the poverty line. Many readers may be surprised to find out that many people "in poverty" do not have access to Medicaid as the program is supposedly "for the poor". Other related facts such as the fact that everyone between 100% and 400% of the poverty line ($23,050 to $92,200 for a family of four) will receive subsidies in order to purchase private health insurance (on a sliding scale from $6K down) are similarly nowhere to be found in this or other pertinent articles printed here. These are facts that most readers of this paper simply do not have. Not only do the readers not know what is at stake, they aren't even informed as to where the relevant person representing their interests stands on the issue! Why is it that the editors feel it sufficient to paint this most vague picture of what the supreme court did in the "non-liberal" component of its ACA decision? Applauds for mentioning that the decision places a somewhat novel power in the court to determine the reasonableness of certain "coercive" legislation. A bit more historical context could have gone a long way in understanding the historic and game-changing nature of this component of the court's decision.

2) Comment by phil - 09/07/2012

Let's see - if you cannot afford health insurance now because you spent your money on other things (like maybe food and gasoline and rent) you will be forced to give up either rent or food or gasoline to pay for health insurance. Then maybe the fact that you cannot afford to pay for all of it might make you fall into the "poverty" category where you will qualify for Medicaid and become another person dependent on the government so someone else can pay your way. It all sounds logical to me?

3) Comment by ceolalong - 09/07/2012

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