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#22 [url]

Jun 28 12 8:47 PM

Quote of the Day

I told him up front. If you go back 60 years what every president tried to do, including my own battle scars from President Clinton and the amount of time and political cost . . . If you’re doing this, you can’t do this, this and this. And you’ve got to weigh that and can you still achieve something on health care vs. also still trying to get other things done.
I told him many times the political cost of doing this and, thank God for the rest of the country he didn’t listen to me. -former Chief of Staff Rahm Emanual on the Supreme Court ruling
The president didn’t listen, and he accomplished much more than conventional wisdom would allow.

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#23 [url]

Jun 28 12 8:48 PM

Fail(s) of the Day

Today has been a magnificent day for the Obama campaign and the millions of Americans who have been assured that they will have access to healthcare, but it’s also been a day filled with astonishing failures among the media and the Right Wing.
For example, the earliest reports out of the Supreme Court today got it wrong.


Screenshots via ThinkProgress, which also has a list of other news organizations that got it wrong including The Huffington Post, NPR, and Time.
According to Politico, these incorrect reports from CNN and Fox News actually lead President Obama to believe it had been overturned for a short time.
A bit crestfallen and anxious for more detail, Obama stood watching the four monitors in the outer Oval Office. A minute later, he was joined by White House counsel Kathryn Ruemmler, who flashed a double-thumbs-up and informed him the report was wrong. [...]
Obama was confused by the cognitive dissonance of what he was hearing from Ruemmler and what he was seeing on TV. For a few seconds, he gazed at the monitors quizzically, and eventually decided to trust his staff over CNN, according to a senior administration official.
Way to go, CNN! Home of the Worst Political Team on Television.
Additionally, today’s ruling lead to some exceptionally unhinged commentary by the usual suspects on the Right
This from Breitbart.com’s Ben Shapiro, who literally wrote the book on Sesame Street turning our children into gay socialists.

And this
Rep. Mike Pence (R-IN) reportedly compared the Supreme Court decision upholding President Obama’s health care law to the September 11 attacks at a closed door GOP meeting on Thursday, several sources tell Politico.
And the crown jewel of shitty punditry, Fox News digial politics editor Chris Stirewalt offered this bit of insight
STIREWALT: I can sum it up this way: at the White House, it’s a good day. The president’s probably very happy that he was vindicated by the Supreme Court. But out in Chicago, at the president’s campaign headquarters, this can not have been the happiest news. I’m sure, from a cynical political perspective, they much rather would have had this issue go away and the Supreme Court take it down so the president could go rally the troops. Instead, it’s Romney’s troops who are rallied.
Got that? This is bad news for Obama because it would have been better for his reelection chances if it had been declared unconstitutional.
For his part Rush Limbaugh also weighed in on today’s events by calling Chief Justice John Roberts an “activist judge.”
Today’s ruling clearly caught the Right off-guard. They were expecting a slam dunk victory for their side.

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#24 [url]

Jun 28 12 8:53 PM

Fail(s) of the Day

Today has been a magnificent day for the Obama campaign and the millions of Americans who have been assured that they will have access to healthcare, but it’s also been a day filled with astonishing failures among the media and the Right Wing.
For example, the earliest reports out of the Supreme Court today got it wrong.


Screenshots via ThinkProgress, which also has a list of other news organizations that got it wrong including The Huffington Post, NPR, and Time.
According to Politico, these incorrect reports from CNN and Fox News actually lead President Obama to believe it had been overturned for a short time.
A bit crestfallen and anxious for more detail, Obama stood watching the four monitors in the outer Oval Office. A minute later, he was joined by White House counsel Kathryn Ruemmler, who flashed a double-thumbs-up and informed him the report was wrong. [...]
Obama was confused by the cognitive dissonance of what he was hearing from Ruemmler and what he was seeing on TV. For a few seconds, he gazed at the monitors quizzically, and eventually decided to trust his staff over CNN, according to a senior administration official.
Way to go, CNN! Home of the Worst Political Team on Television.
Additionally, today’s ruling lead to some exceptionally unhinged commentary by the usual suspects on the Right
This from Breitbart.com’s Ben Shapiro, who literally wrote the book on Sesame Street turning our children into gay socialists.

And this
Rep. Mike Pence (R-IN) reportedly compared the Supreme Court decision upholding President Obama’s health care law to the September 11 attacks at a closed door GOP meeting on Thursday, several sources tell Politico.
And the crown jewel of shitty punditry, Fox News digial politics editor Chris Stirewalt offered this bit of insight
STIREWALT: I can sum it up this way: at the White House, it’s a good day. The president’s probably very happy that he was vindicated by the Supreme Court. But out in Chicago, at the president’s campaign headquarters, this can not have been the happiest news. I’m sure, from a cynical political perspective, they much rather would have had this issue go away and the Supreme Court take it down so the president could go rally the troops. Instead, it’s Romney’s troops who are rallied.
Got that? This is bad news for Obama because it would have been better for his reelection chances if it had been declared unconstitutional.
For his part Rush Limbaugh also weighed in on today’s events by calling Chief Justice John Roberts an “activist judge.”
Today’s ruling clearly caught the Right off-guard. They were expecting a slam dunk victory for their side.

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#25 [url]

Jun 28 12 9:01 PM

Rand Paul is an Idiot

Libertarian boy wonder Kentucky Senator Rand Paul’s response to today’s Supreme Court ruling on the Affordable Care Act.
Just because a couple people on the Supreme Court declare something to be ‘constitutional’ does not make it so. The whole thing remains unconstitutional. While the court may have erroneously come to the conclusion that the law is allowable, it certainly does nothing to make this mandate or government takeover of our health care right.
Actually, that’s exactly what it means. For all intents and purposes, when the Supreme Court declares something constitutional, it will remain as such until the Supreme Court declares otherwise or the constitution is amended.
I seem to recall learning that during social studies class sometime between 4th and 5th grade. And I’m from Kentucky.

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#26 [url]

Jun 28 12 9:03 PM

Rand Paul is an IdiotPosted on 06/28/2012 at 4:00 pm by JM Ashby Libertarian boy wonder Kentucky Senator Rand Paul’s response to today’s Supreme Court ruling on the Affordable Care Act.Actually, that’s exactly what it means. For all intents and purposes, when the Supreme Court declares something constitutional, it will remain as such until the Supreme Court declares otherwise or the constitution is amended.I seem to recall learning that during social studies class sometime between 4th and 5th grade. And I’m from Kentucky.

-lomaparda566

you know who's even more stupid and more doltish than Rand Paul? The moron Repukes who voted for that piece of crap.

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#28 [url]

Jun 28 12 9:28 PM


Fail(s) of the DayPosted on 06/28/2012 at 5:00 pm by JM Ashby Today has been a magnificent day for the Obama campaign and the millions of Americans who have been assured that they will have access to healthcare, but it’s also been a day filled with astonishing failures among the media and the Right Wing.
For example, the earliest reports out of the Supreme Court today got it wrong.
[image]
[image]
Screenshots via ThinkProgress, which also has a list of other news organizations that got it wrong including The Huffington Post, NPR, and Time.
According to Politico, these incorrect reports from CNN and Fox News actually lead President Obama to believe it had been overturned for a short time.
Way to go, CNN! Home of the Worst Political Team on Television.
Additionally, today’s ruling lead to some exceptionally unhinged commentary by the usual suspects on the Right
This from Breitbart.com’s Ben Shapiro, who literally wrote the book on Sesame Street turning our children into gay socialists.
[image]
And this
And the crown jewel of shitty punditry, Fox News digial politics editor Chris Stirewalt offered this bit of insight
Got that? This is bad news for Obama because it would have been better for his reelection chances if it had been declared unconstitutional.
For his part Rush Limbaugh also weighed in on today’s events by calling Chief Justice John Roberts an “activist judge.”
Today’s ruling clearly caught the Right off-guard. They were expecting a slam dunk victory for their side.

-lomaparda566

What has happened to CNN? They have really gone to shit. Are they trying to best Faux News?
                                    

Are Lies All Republicans Have?

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#29 [url]

Jun 29 12 8:39 AM


What has happened to CNN? They have really gone to shit. Are they trying to best Faux News?                                    [image] 

-rliesallrshave

Maybe they need the FauxSnooz's crowd's ratings.

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#31 [url]

Jun 29 12 11:44 AM

June 28, 2012

JAMA Forum — The Health Care Law Stands: Now What?
Tags: The JAMA Forum

By David M. Cutler, PhD
The JAMA ForumThe Supreme Court has decided the Affordable Care Act (ACA) is constitutional. Their reasoning was tortured, but they got to the right answer. This is very good news. We now have a law passed by Congress, signed by the President, and declared constitutional by the US Supreme Court.
If these were normal times, we would be finished. But nothing is normal in politics these days.  Already, the Right is vowing to push on to call for repealing the ACA this fall and early next year. So, what happens next?
The real political hurdle is the upcoming election. If President Obama wins reelection, the law goes into effect as it stands today—symbolic votes to repeal it notwithstanding. If Mitt Romney wins, the situation is less certain. Romney has promised to repeal and replace the ACA and he reiterated that after the Supreme Court ruling. But go past the requirement to purchase minimum coverage and repeal is not so popular. Should insurers be required to accept all comers, healthy and those with preexisting conditions, at equal rates? Should the “doughnut hole” gap in Medicare’s coverage for prescription drugs be filled in? Should children be able to remain on their parents’ policy up to age 26? These are all popular provisions and are all included in the ACA. Thus, repeal is unlikely to be very popular.
Further, replacement of the ACA is not likely to go well for Romney. As I noted in an earlier post, Romney’s proposed replacement for the ACA is to dramatically reduce Medicaid payments and reenact the insurance provisions of the Health Insurance Portability and Accountability Act of 1996. Let President Romney propose those ideas and we are likely to find that keeping major parts of the ACA looks even better.
That is why it seems likely that the ACA’s major provisions are almost certain to remain the law of the land, regardless of the outcome of this fall’s Presidential election. The real issue is how to make the principles in the ACA work. Because of the recession and uncertainty about whether the law would stand, implementation of the health care law has been slower than it might have been. Will it speed up? Here are 3 areas to look for in the next few months:
(1) Do more states set up insurance exchanges? The ACA allows states to establish exchanges, with the federal government stepping in if the states do not. To date, 15 states have established exchanges, 1 is planning for a partnership exchange, and 18 are studying their options. That leaves 17 states with no exchange activity or that have actively decided not to pursue exchanges. Some of the states with no activity were waiting to see if the law would be overturned. With the law in place, will those states start to explore exchanges? Will those mulling their options start to implement? Or will both groups be content to let the federal government operate an exchange on their behalf?
(2) Does the pace of reform of the health care delivery system accelerate? Clinicians and others have been caught in an in-between world where most of Medicare payment is on a traditional fee-for-service basis, but where the federal government is encouraging them to move to bundled payment models. The difference between these models is profound. In the traditional model, providing more care nets more; in the bundled payment world, more care lowers profits. Not knowing which way policy is going makes the investment and care coordination decisions of physicians and hospitals very difficult. Now that there is more certainty about the law, the shift to bundled care payments is likely to accelerate. That could spur action at institutions throughout the country, as clinicians and hospital administrators seek to cut unnecessary care and streamline their operations.
(3) Will states start to plan for the Medicaid expansion? The single modification the Supreme Court made to the ACA was to limit the penalties for states that do not expand Medicaid. The ACA said that if states did not expand Medicaid, they would lose all of their Medicaid funding. The Supreme Court argued that loss of all Medicaid funding would be too coercive and limited the penalty to losing the funding only for newly covered individuals. The additional funds for the newly covered are largely federal: all of additional funds for the newly covered will come from the federal government when the expansion begins in 2014, and the federal government is committed to paying 90% by 2020. Thus, governors and legislators in those states need to decide whether their opposition to the ACA extends to turning down hundreds of millions of federal dollars with virtually no commitment of their own. Will they start to plan for Medicaid expansion? If not, how will physicians and hospital executives in those states react?
The Supreme Court decision has allowed health care reform to move forward. If the act had been repealed, the nation would almost certainly have been stuck without change for the foreseeable future. Now, at least, there is a chance for progress in this arena. Whether there’s enough follow-through to make this time more successful than in the past depends on whether enmity for the law and for President Obama overwhelms the desire to do more for those in real need.

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#32 [url]

Jun 29 12 11:47 AM

How states are getting ready for ACA Medicaid changes today

Aaron Carroll
http://theincidentaleconomist.com/wordpress/how-states-are-getting-ready-for-aca-medicaid-changes-today/
May 21, 2012
The Kaiser Family Foundation has a great report out on how changes to Medicaid in the ACA are already happening today. Here are the take home points:
1. Getting an early start on the Medicaid expansion. Starting April 2010 the ACA provided states a new state plan option to cover adults with incomes up to 133% FPL to get an early start on the 2014 Medicaid expansion. Since April 2010, eight states (CA, CT, CO, DC, MN, MO, NJ, WA) have received approval to expand Medicaid to adults early through the new option and/or a Section 1115 waiver.
2. Increased federal funding to upgrade Medicaid eligibility systems. In April 2011, the federal government approved a temporary funding opportunity, under which states can receive a 90% federal funding match for the design, development, and implementation of major upgrades or new Medicaid eligibility systems, up from the regular 50% administrative matching rate. As of January 1, 2012, 29 states had approved or submitted plans to overhaul or build new systems, and most of the remaining states indicated interest in pursuing an upgrade during 2012.
3. New federal Medicaid funding for disease prevention. Medicaid Incentives for Prevention of Chronic Disease (MIPCD), established by the ACA and administered by CMS, provides a total of $85million over five years (January 1, 2011-December 31, 2015) to test the effectiveness of providing financial and non-financial incentives to Medicaid beneficiaries who participate in prevention programs and demonstrate changes in health risk and outcomes. As of January 1, 2012, ten states (CA, CT, HI, MN, MT, NH, NV, NY, TX, WI) received the first round of MIPCD grant awards.
4. Health homes for individuals with chronic conditions. The ACA provides states with a new option to reform the delivery system for beneficiaries with chronic conditions by providing “health home” services and authorizes a temporary 90% federal match rate for these services. As of April 2012, CMS has approved six state plan amendments (SPA) in four states to provide health home services: two in MO; two in RI, one in NY, and one in OR. There are two additional health home SPAs under review in NC and WA, and CMS is reviewing draft proposals in five states (AL, IA, IL, OH, OK). In addition, CMS has approved funding requests from 15 states for planning activities to develop a health home SPA.
5. Integrating financing and care for dual eligible beneficiaries. As provided by the ACA, in April 2011, the Center for Medicare and Medicaid Innovation, working with the CMS Medicare-Medicaid Coordination Office, awarded design contracts of up to $1 million each to 15 states to develop service delivery and payment models integrating care for beneficiaries dually eligible for Medicare and Medicaid. In addition, as of April 2012, 26 states including the 15 with design contracts) have submitted proposals to test models of integrated care and financing for dual eligible beneficiaries.
I’ve been beating the drum on the importance of, and the magnitude of, Medicaid reforms in the ACA. Although the expansion set to occur in 2014 is what everyone focuses on most, the changes that have occurred already are quite substantial. Should the Supreme Court strike down the entire law next month, rolling back these changes will be incredibly disruptive. The same will be true should the law be repealed next year. As time goes on, “repealing” may be just as politically difficult as “replacing”.

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#33 [url]

Jun 29 12 11:52 AM

What happens if a state refuses to expand Medicaid?

Austin Frakt
http://theincidentaleconomist.com/wordpress/what-happens-if-a-state-refuses-to-expand-medicaid/
June 28, 2012
The Supreme Court decided today that states can refuse the ACA Medicaid expansion without having to give up federal funding for their existing Medicaid program. This was the threat in the ACA, the stick that was intended to pusuade (or coerce, if you like) states into compliance. According to the court, that stick is unconstitutional. In terms of health policy, this is the most significant aspect of the court’s ruling.
On Twitter, I’m seeing a lot of questions about what happens to the would-be Medicaid eligible people in states that refuse the ACA Medicaid expansion. I believe that Jared Bernstein has it right:
Because the law was written assuming that the uninsured poor would be covered by Medicaid, subsidies to purchase health insurance in the exchanges don’t kick in until higher income levels [above the federal poverty level*]. The poor won’t have to pay the tax penalty formerly known as the mandate because of a hardship exemption in the law, but neither will they get the subsidy until their incomes go up enough.
It’s a very weird reversal of the usual means-test for government benefits.  Typically, as your income rises you become ineligible for benefits.  Here, you become eligible.
I agree with Bernstein and Aaron and Kevin Drum (all posts worth reading) that it is unlikely many states will actually refuse the money that comes with Medicaid expansion due to the pressure they’re likely to receive from providers. But it is possible some may try, and in particular they may do so to extract concessions from regulators. “Hey, let that waiver through and we’re on board.” It’d be an ugly game, threatening the affordability of coverage of low-income individuals, but that doesn’t mean some states won’t play it.
*UPDATE: I originally wrote 133% of FPL. See a the follow-up post for some additional detail.

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#34 [url]

Jun 29 12 11:54 AM

What happens if a state refuses to expand Medicaid? Ctd.

Austin Frakt
http://theincidentaleconomist.com/wordpress/what-happens-if-a-state-refuses-to-expand-medicaid-ctd/
28 June, 2012
John Graves, Assistant Professor at Vanderbilt University School of Medicine, writes me about my prior post,
Just wanted to touch base briefly on the Medicaid ruling and your post from today.  [...] What Jared B. says is basically true.  But it’s actually folks <100% (not <133% FPL) that are ineligible for exchange subsidies.  The ACA allows for a small sliver of folks between 100-133% FPL, who AREN’T eligible for Medicaid, to claim the exchange premium tax credit (and for them, the credit caps their contribution to the premium at 2% of income).   So if a state decides to opt out of the expansion, that leaves folks under 100% likely exempt from the mandate, but with no access to federal subsidies.
Interestingly, this point was key in the constitutional challenge of the Medicaid expansion.  Since the exchange premium tax credit schedule begins at 100% FPL and not 0% FPL, it was argued, the ACA basically assumes that states will keep their Medicaid programs to cover folks under the poverty line.  This, they argued, is coercion.  Jim Blumstein, my colleague here at Vanderbilt, has written extensively on this — both in a NEJM perspectives piece last fall, and in an Amicus brief filed in the Florida challenge against the ACA.
Here’s the NEJM piece (see bottom of 2nd paragraph) and here’s the amicus brief (pdf, see top of page 16).

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#35 [url]

Jun 29 12 11:56 AM

The Constitutionality of the ACA's Medicaid-Expansion Mandate

I. Glenn Cohen, J.D., and James F. Blumstein, L.L.B.

http://www.nejm.org/doi/full/10.1056/NEJMp1113416

January 12, 2012

Nearly all media and scholarly discussion of the constitutionality of the Affordable Care Act (ACA)1,2 has focused on the individual mandate to obtain health insurance. The Supreme Court has now promised to review not only that issue but also the issue of whether the ACA's Medicaid expansion violates the U.S. Constitution.

The individual mandate requires nonpoor persons to purchase medical insurance if they are not otherwise adequately covered. The federal government will subsidize these purchases for persons with incomes of 100 to 400% of the federal poverty level. There is no federal subsidy for persons with incomes below the federal poverty level, who are presumed to be covered under states' Medicaid programs.1,2

In addition, the ACA requires that state Medicaid plans, starting in 2014, cover all persons under 65 years of age with individual or family incomes up to 133% of the federal poverty level. This requirement represents a significant change: Medicaid has not previously set a baseline income level for mandatory eligibility for adults. When fully phased in (in 2020), the ACA will provide 90% federal matching funds for newly eligible beneficiaries — a matching formula substantially more generous than that for currently eligible beneficiaries. To remain eligible for any federal Medicaid matching funds, states must accept these new requirements. Moreover, state participation in traditional Medicaid will no longer be possible, since the current terms and conditions of federal support will cease to apply in 2014.1-3
Only the lawsuit brought by Florida, joined by 25 other states, has challenged the ACA's mandatory Medicaid-expansion requirements. The 11th Circuit Court of Appeals rejected that challenge, but the Supreme Court has granted review on this issue, allocating it a full hour of argument.

The challenge centers on the Constitution's Spending Clause. As the Supreme Court has explained, “legislation enacted pursuant to the spending power is much in the nature of a contract: in return for federal funds, the States agree to comply with federally imposed conditions” that “fix the terms” on which states “disburse federal money.”4

Congress has broad authority to set conditions on its spending, but Florida's challenge raises two limits: federal conditions must be unambiguous, ensuring that states are given clear notice of their obligations when they accept federal funds so that they can knowingly exercise their choice (which is protected under the Constitution) about whether to participate; and the federal government may not employ the spending power in such a way as to “coerce” the states into compliance with federal objectives. Though the federal government may not force states to participate in federal programs, it may use financial incentives to induce them to do so (as Congress did with the original Medicaid program). But as a 1987 Supreme Court decision put it, “in some circumstances the financial inducement offered by Congress might be so coercive as to pass the point at which [permissible] pressure turns into [impermissible] compulsion.”5

Applying this distinction, the 11th Circuit noted that “Congress cannot place restrictions so burdensome and threaten the loss of funds so great and important to the state's integral function as a state — funds that the state has come to rely on heavily as part of its everyday service to its citizens — as to compel the state to participate in the `optional' legislation. This is the point where `pressure turns into compulsion.'”3 Nevertheless, the court found that the Medicaid-expansion mandate constituted pressure rather than compulsion, for four reasons.

First, states were warned from the beginning that Congress reserved the right to make changes to Medicaid, and at each subsequent amendment stage, states could choose between complying with the changes and losing all or part of their funding. None of these amendments have been struck down as coercive.3 This is not a very strong argument, in our view, since none of the Medicaid amendments were challenged as coercive before the Supreme Court or even the circuit courts. Moreover, Florida will probably argue that since a contract between private parties suggesting that “we can change the terms completely and unilaterally at any time” would be unenforceable, such a contract between the federal government and the states should be unenforceable as well, and also that the states' authority to refrain from entering into such a contract is constitutionally protected and cannot be waived. It is unclear how the Supreme Court will resolve this issue.

Second, the federal government will bear 90% of the costs associated with the expansion once it is fully phased in. The 11th Circuit found this fact insufficient to constitute coercion,3 but it's possible that the Supreme Court may view it as an “offer you can't refuse.” Florida will probably argue that the determination of coerciveness must be made from the states' perspective and that even a 10% copayment overly stretches state budgets, given the mandated expansion of eligibility.

Third, states have 4 years from the date the ACA was enacted to decide whether to stay in Medicaid by adopting the expansions and thus have had significant notice and time to deal with the expansion. Fourth, and relatedly, states can tax and raise revenue and therefore can create and fund their own programs if they don't like Congress's new terms.3
On these points, Florida will probably argue that the relevant notice must be given at the program's start (contract formation), not midway through (contract modification). The idea is that once states have bought into a cooperative federalism program such as Medicaid, the federal government cannot engage in a “bait and switch” by substantially and unforeseeably altering the terms in a way that is fiscally onerous for the states.
Florida will probably contend that linking these changes to continued participation in the preexisting Medicaid program is a form of excessive leveraging, offering states an untenable choice: give up a large existing program (an ongoing contract) entirely or accept additional financial burdens that states have a right not to incur. Florida will most likely argue that the lack of federal subsidies for persons with incomes below the federal poverty level strongly suggests that Congress was betting that no state could realistically exit Medicaid entirely, thereby leaving the poorest and most vulnerable persons without federal support, whereas those with incomes of 100 to 400% of the poverty level were receiving new federal subsidies for purchasing health insurance.
These are the arguments that ACA opponents are likely to press in the Supreme Court. Their success is an open question. On the notice-timing issue, the challenge is to articulate a clear way of drawing the line that will allow the Supreme Court to find the Medicaid expansion unenforceable, while not casting into doubt all other forms of cooperative federalism. One of us has recommended a two-part test that would examine, first, whether the proposed modification is substantial and unforeseeable and, second, whether it has a major financial effect on a program that represents a substantial component of a state's budget. That test would require a series of difficult judgment calls, and the Supreme Court may be reluctant to get the federal courts into the business of evaluating the terms of modifications to federal programs.
What will the Supreme Court do? The 11th Circuit rejected this challenge, and many constitutional lawyers would have pronounced the issue dead. By granting review of it and explicitly allocating it an hour of argument, the Court has signaled that it takes the matter seriously. Should the expansion be struck down, as a constitutional matter there is nothing to prevent Congress from declaring that Medicaid as we know it has ended and enacting “Medicaid 2.0,” including the expansion provisions, and leaving states free to decide whether to sign up. However, in practice, such a move could prove to be politically unpopular and would be unlikely to gain traction in Congress.

Disclosure forms provided by the authors are available with the full text of this article at NEJM.org.
This article (10.1056/NEJMp1113416) was published on December 7, 2011, at NEJM.org.

Source Information

From Harvard Law School, Cambridge, MA (I.G.C.); and Vanderbilt Law School, Nashville (J.F.B.).

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