In the victory on the Affordable Care Act last week came a few disappointments. This is one of them, and one of the most important:
But what happens if states choose not to expand Medicaid to meet the new guidelines? That’s where the conservative majority, joined by liberals Stephen Breyer and Elana Kagan, surprised a lot of people. As the law was originally written, the entire Medicaid package became an all-or-nothing deal: States that didn’t want to meet the new, more expansive guidelines were free to do so. But choosing that option meant forgoing all federal Medicaid money. The Court on Thursday ruled that choice was “coercive.” Roberts, echoing the arguments of the law’s challengers, likened it to holding a gun to the states’ heads.The remedy was not as extreme as it might have been: The justices didn’t strike down the Medicaid expansion altogether. But they insisted that states choosing not to expand coverage give up only the money that would have gone to covering the new populations. Those states would remain eligible for the funds that they already get, to cover people who already qualify for Medicaid under the old guidelines.
Even though the courts were pretty adamant that the individual mandate was a tax, it does not mean every tax will be allowable. And it won’t surprise me if another lawsuit is forthcoming on that point with respect to ACA, anyway.
(Cross-posted to Simply Left Behind.)