Supreme Court Ruling: Uncertain Future for Medicaid Expansion

[dkf]

One portion of the Supreme Court’s 5-4 decision to effectively uphold the Affordable Care Act (ACA) could have profound implications for the law’s goal of universal health coverage: it appears states could opt out of raising their Medicaid eligibility standards to 133 percent of the federal poverty level in 2014 without losing their existing federal Medicaid funding as a result.

The ACA’s Medicaid provision is expected to extend coverage to up to 17 million people within the next decade. But the teeth of the provision, as originally conceived, was that the law gave the U.S. Department of Health and Human Services (HHS) the authority to withhold some or all of a state’s federal Medicaid match (between 50 and 75 percent of each state’s spending for the program) if the state did not adopt the new eligibility standards.

Chief Justice John Roberts, writing for the majority, declared that the Medicaid eligibility expansion is constitutional, but that it is unconstitutional for HHS to withhold existing federal Medicaid funding for states that don’t comply. That could neuter the Obama administration's ability to enforce the expansion.

"Nothing in our opinion precludes Congress from offering funds under the ACA to expand the availability of health care and requiring that states accepting such funds comply with the conditions on their use,” Roberts wrote. “What Congress is not free to do is to penalize states that choose not to participate in that new program by taking away their existing Medicaid funding."

http://www.governing.com/blogs/view/gov-supreme-court-ruling-uncertain-future-for-aca-medicaid-expansion.html

[PoliticAverse]

1. Btw the vote on the Medicaid expansion issue was 7-2. n/t

[dkf]

2. What was the issue? That they could mandate expansion or that they

Couldn't withhold funds?

[PoliticAverse]

4. They couldn't penalize states that didn't participate in the ACA's Medicaid expansion...

by removing all funds the states are receiving under the current Medicaid program.

The court found that to be unconstitutional 'coercion'.

[dkf]

9. Interesting. Thanks.

[bluestateguy]

3. The word "uncertainty" is a Wall Street corporate word

So I do not take any news story seriously that uses it.

[PoliticAverse]

5. Are you certain which states won't participate in the Medicaid expansion ? n/t

[DearAbby]

6. Those who didn't get their way....

GOP governors who are upset because they didn't get their way. They are taking the entire population, currently in poverty, working poor, the middle class, within their state, as hostage. Their lives used as chips in a poker game....its called a BLUFF.

It will only work if we respond. Just kids, holding their breath to get their way. Stay firm, we are the adults here.

[TheKentuckian]

7. It isn't bluffing when they go through with it.

Ignoring it won't make it go away and it can't be allowed, if at all possible, because you essentially force the sickest and poorest to move where they can get care if they can find any way to do it stressing programs that did move forward and those who can't get out are advised to die and to die quickly, maybe mocked by heartless fucks as well.

The value is being diminished, the percentage of "loaf" shrinks.

[Igel]

8. Not quite.

Those currently covered are still funded. That's those in poverty, with some exceptions both up and down the scale (depending on state).

The only people "at risk" are those not currently funded. And it's not like they're under threat of anything except the risk of not getting additional Medicaid coverage. I have trouble saying that things that might exist already do exist. A bit too abstract when thinking about actual reality.

Then again, I think of threats as being of the form "Do this or I'll do this bad thing." Either you do something or I'll do something to hurt you or somebody else. That "bad thing" might be injuring the person your threatening or injuring somebody/something that the threatened person cares about.

The governor's threats were basically, "Rescind this provision or I'll be deprived of federal money and that will hurt the poor." It's oddly passive. It's not really a good threat.

Worded from the ACA's perspective you get, "Adopt this provision or I'll take away the federal money you already have and that will hurt the poor." That's a threat. It's the threat that Congress intended the bill to bear. It's not like Congress put that in there just so Obama could be the subject of a strangely worded not-quite-threat.

But I agree, the poor would be those held hostage. Not the poorest of the poor, for the most part, but that varies by state. There's a lot of this kind of mercenary hostage-taking in contemporary American politics, a hostage-taking that depends on its efficacy by virtue of framing and spin. "I make the threat, but I intend to show that the threat is reasonable and not complying with my threat is the real danger." Sometimes it works sometimes it doesn't. But this incessant treating of people as chattel really has to stop.