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.