Is ObamaCare’s Medicaid Expansion Constitutional?

This is actually a more interesting question than I originally thought. Here is Robert Book at the Apothecary:

The health reform law passed in March 2010 provides for a substantial expansion of the “must cover” population – essentially anyone from a family with income below 138% of the federal poverty line (an amount that varies based on family size). This is a major component of the health reform law: according to the Congressional Budget Office, half the uninsured who they project to become covered as a result of new law will obtain coverage because of the Medicaid expansion…

The constitutional issue, however, is what would happen if a state declined to pay for that portion of the Medicaid expansion not paid for by the federal government? Suppose, for example, a state decided to just forgo the expansion entirely, on the grounds that it could not afford to pay its share of the cost? In that case, the health reform law contains a built-in retaliation – the state would lose all federal Medicaid funding.

Comments (8)

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  1. Buster says:

    The federal government is supposed to pay 95% of the cost of Medicaid expansion through 2019. States are finding there are plenty of loopholes, however. For instance, federal funds to increase physician reimbursements are only funded for two years. Yet, policy analysts know that if the (newly expanded) Medicaid population is to have access to doctors willing to treat them, the states will have to continue paying doctors the higher rates.

  2. Joe S. says:

    Good post.

  3. Carolyn says:

    Wow! The problems in this law are never-ending.

  4. Joe Barnett says:

    Couldn’t all the Medicaid eligible people just go the insurance exchange set up by the federal government in that state (although how the federal government logistically will be able to do that remains to be seen)?

    For those who don’t qualify for the exchange, the states will have a whole lot of money previously spent on Medicaid that they can send to their safety net hospitals without the mandates & regulations of Medicaid.

  5. Brian says:

    I predict that at least one state will decline to pay the portion not paid for by the federal government.

  6. Linda Gorman says:

    And then there’s the maintenance of effort requirement. States that might want to cut back on optional parts of Medicaid that they expanded but have proven to be too expensive, too difficult to control, unnecessary, and so on, are not allowed to do so.

  7. Lori Taylor says:

    Medicaid helps so many of the low-income population, especially children. Even though we are already in a rut with debt, it could potentially be harmful to these people if the state were to forego funding the Medicaid expansion if not covered by the federal government. Even worse, a state losing all Medicaid federal funding for not cooperating would be very detrimental for many. The United States is considered one of the most powerful in the world though we can’t provide sufficient health insurance because no one wants to be held liable for the costs.

  8. KERZMEN says:

    How the laltsgeiure killed lumber in Oregon is for a different topic, but suffice it to say that the evidence is clear: Lumber is a minor slice of Oregon?s economy, and, until recently, was a major portion. Laws changed that; not lack of demand or lack of supply. But that is not a Measure 66 67 issue, so I want to stay on topic.The lessons of Plymouth Plantation must be learned once again. Michigan?s thriving economy has been decimated by an entitlement mentality. Henry Ford determined the best road to success was to pay his employees enough so they could afford to buy the cars they were making. He set the stage for Michigan?s booming economy. If he thought small, the workers would have been paid less and he might personally have been richer, but he struck a good balance that benefited everyone beyond anyone?s wildest dreams. If the workers were overpaid, the company would have faltered and been swallowed up by some other company (not unlike what has happened recently). There has to be a balance. The free market ought to determine the proper balance.Unfortunately, taxes upset that balance when they are not adapted to the times. Increasing taxes in times of economic distress upsets the balance. When the government sucks more money out of its major industries in times of trouble and keeps demanding more from the successful people, then the entrepreneurial incentive is diminished, and companies and individuals look elsewhere to invest their time in order to reap the rewards of their labor, or they just stop working so hard. This is a natural function of the free market. This is one of the reasons why Measures 66 and 67 are so corrosive, especially during a bad economy.When people stop working and expect a handout from the government because they feel entitled to a handout, that handout has to come from somewhere. The natural place for government to get the handout is from those who are industrious, since they seem to have so much. That is similar to how it worked at Plymouth Plantation at the beginning. It was a communal situation where all shared alike in the benefits of the community?s labor, and resulted in near starvation. Not until each person was allowed to farm his own land and keep the fruits of his own labor did the colony thrive.