Two cases before the Supreme Court have the potential to effectively do what Republican lawmakers have tried and failed: transform Medicaid into a block grant program for states with few enforceable federal rules about how they provide health coverage for the poor.
That outcome may not be the most likely scenario. But legal experts say no one can predict what the high court will do ? particularly because many were surprised that the Supreme Court agreed to consider the Medicaid portion of the big multistate challenge to President Barack Obama?s health reform law in the first place.
Continue ReadingShould the courts rule against the Obama administration and back the states? contention that Medicaid expansion under the health reform law is unconstitutional, it would severely limit Washington?s ability to tell the states: If you want the federal Medicaid funds, you have to follow the federal Medicaid rules.
And that outcome ? federal money but few federal strings attached ? would be much like the block grant approach that Republicans have periodically attempted, most recently in last year?s House budget.
The second Supreme Court case, arising from a dispute over California Medicaid payment rates to health care providers, could give states even more latitude to run their programs by limiting individuals? right to argue in court that a state Medicaid policy violates federal law.
The federal health reform case has gotten more attention than the California pay dispute, but the Medicaid aspect has been overshadowed by the fight over the individual health insurance mandate. But last week, the 26 states challenging the law filed a brief arguing that Congress exceeded constitutional limits by telling states how to run their Medicaid programs. The health law requires expansion of Medicaid to populations not previously covered starting in 2014, although the feds are picking up the tab in the first years and most of the cost for several years thereafter.
The other case, Douglas v. Independent Living Center of Southern California, was argued in October. The court will decide whether individual Medicaid beneficiaries and providers can sue California for cutting payment rates to the point that they say violates federal rules.
Should the court make sweeping rulings in both cases, legal experts say federal law will no longer have much power to bind state decisions on Medicaid, including who?s eligible, what benefits are covered and how much to pay providers. In short, it would become a lot like a block grant.
Under that scenario, ?the program is fried,? said Washington and Lee law professor Tim Jost, who argued for upholding the health reform law?s Medicaid provision in a recent New England Journal of Medicine essay. ?It ceases to be Medicaid as we know it.?
?Medicaid could go the way of the dodo,? agreed Harvard Law School?s I. Glenn Cohen, author of another NEJM piece that argued the opposite ? that the court should block Medicaid expansion.
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