Well, it’s complicated.

Posted March, 29 2012 by arianne

Yesterday wrapped up the final day of ACA oral arguments before the Supreme Court and the future of the health reform law still remains unclear.

The final day of arguments focused on two main points: Can the individual mandate be separated from the rest of the law, and does the law’s Medicaid expansion put undue hardship on states?

On the first question on the severability of the mandate, opponents of the law claim that if the individual mandate is struck down then the entire law should just be scrapped.  The idea here is that the mandate is pivotal to too much for the law to work without it (funny, because the many different parts of the law already in place seem to be working just fine now, but maybe that’s just my own opinion).

On the flip side, supporters say that if the mandate is struck down then only one or two related bits of the law should go, but not the whole thing.  But, turns out its harder to argue for reworking the law and fixing the holes left should the mandate be pulled than to just go back to the drawing board (single-payer, anyone?).  And, if you read Henry Aaron’s recap (below) it appears that maybe the government didn’t actually want to win the severability argument anyways, because it will just make it that much easier for the court to strike down the individual mandate.

The second argument, regarding Medicaid, played out a bit differently.  Basically, under the ACA, the eligibility level for Medicaid is being expanded up to those who earn up to 133% of the federal povertyr level (just under $15,000 per year).  To pay for this increase in the Medicaid rolls, the federal government will pay 100% of the cost, and then 90% after 2020.  Just to give a reference point here, in New York the feds pay for about 50% of our Medicaid program.  So, yeah, even 90% is pretty generous.

The point of contention here, however, is that the ACA also gives the Secretary of Health and Human services the power to take away all Medicaid funding for any state that chooses not participate in the expansion.  Opponents of the law say that this amounts to coercion.  Basically, they are saying that they don’t want to have to accept tons of free money to give more of their constituents free quality healthcare.

But, just because the Secretary can take away Medicaid funding doesn’t mean she will.  Why punish the poor for having bad state policymakers?  Besides, there have been other Medicaid expansions in the past that carried similar requirements for states, and none of those ever resulted in a state losing funding.

Again, the court arguments never really seemed to waiver from party lines.  Conservative justices tended to agree with opposing arguments.  More liberal justices went with supportive arguments.  But, that doesn’t necessarily mean anything at this point.  The real decisions will all be made behind closed doors in the next few months.  So, I guess that’s all she wrote for now!

To beef up a bit more on the proceedings of Day 3, here are a few good summaries from around the web: