Supreme Court And The Medicaid Expansion


While the more publicized aspect of the Affordable Care Act (“Act”) was the requirement that all Americans purchase health insurance, there was another aspect of the Act that was equally important to the states and many people: the Medicaid Expansion. However, the Court limited this aspect of the Act by finding it exceeded Congress’s power, despite the Court’s finding a way to make the individual mandate constitutional.

The Medicaid expansion aspect of the Act sought to expand Medicaid by making more people eligible and tying more Federal funding to Medicaid in each state. The law originally stated that if states did not expand Medicaid per the Act they would lose out on Federal funding.

However Chief Justice Roberts stated that, “The Court today limits the financial pressure the Secretary may apply to induce States to accept the terms of the Medicaid expansion. As a practical matter, states may now choose to reject expansion; that is the whole point.”

Essentially, Chief Justice Roberts was saying that states could not be threatened with the loss of Federal funding if they chose not to enroll in the expansion of Medicaid in their respective states. Basically, Medicaid doesn’t have to be expanded in states if the states do not want to expand. Now the fear is that less people will be eligible for Medicaid because it will be easier for states to opt out.

Interestingly, while the focus has been on a conservative Chief Justice Roberts upholding the individual mandate, two liberal Justices actually joined the conservatives in the Medicaid expansion holding.

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