In late March, the Supreme Court finished hearing oral arguments on the case challenging the Affordable Care Act, the health care reform law passed early in the Obama administration. Though much of the media attention has focused on whether the so-called “individual mandate” is constitutional, the Medicaid expansion provisions, and how the Court rules on it, may turn out to be the key legal legacy of this case.
Under the Affordable Care Act, Medicaid coverage will extend to Americans based not just on their condition, but on whether an individual meets specific poverty criteria. This expansion will bring Medicaid coverage to millions more Americans than had been previously covered under the program. Medicaid is a partially federally funded program that states can voluntarily enter into to receive federal funding. Part of the argument against the healthcare legislation is that by forcing the new standards the federal government is coercing states into participating.
If the Supreme Court agrees with the coercion argument, this may jeopardize other federal programs that use a similar voluntary participation method. For example, highway funding programs, educational funds, child welfare programs and other federally assisted or created projects may be similarly affected. Though no lower court has ruled that the Medicaid expansion is coercive, many people saw it as surprising that the Supreme Court decided to hear the issue at all, which may indicate the court’s willingness to rule the law coercive.