States link health law’s Medicaid expansion to individual mandate

The 26 states challenging President Obama’s healthcare law sought to link the law’s Medicaid expansion to its individual insurance mandate in a brief filed with the Supreme Court on Tuesday.

The states say the law’s Medicaid expansion is coercive — that it goes beyond the program’s traditional federal-state partnership and essentially requires states to participate in Medicaid.

No federal court has sided with the states on that point, but the Supreme Court nevertheless agreed to hear the Medicaid challenge along with the states’ suit over the requirement that almost everyone purchase insurance.

“After months of litigation and hearings, not a single judge agreed with the claim that Congress couldn’t expand Medicaid," an administration official said. "We are confident this trend will continue and that the Supreme Court will rule in our favor."

The states tried to link the Medicaid expansion to the mandate in their brief Tuesday.

Medicaid is technically a voluntary program. But the states said the healthcare law makes participation all but mandatory because it does not consider alternatives if a state would choose to stop participating in Medicaid.

The healthcare law requires states to enroll in Medicaid everyone with an income at or below 133 percent of the federal poverty level. People with slightly higher incomes will be eligible for subsidies from the federal government to help buy private insurance through a newly created exchange.

The states said in their brief, however, that the law doesn’t spell out alternatives for people whose incomes would make them Medicaid-eligible but who live in a state that elects not to participate in Medicaid because of the expansion.

“While the [Affordable Care Act] purports to leave States’ participation in Medicaid nominally voluntary, multiple aspects of the Act evince Congress’ keen awareness that, in fact, no State will be able to reject its new terms and withdraw from the program,” the brief says.

The healthcare law also says that Medicaid-eligible people who try to buy coverage through an exchange should be automatically enrolled in Medicaid instead. The states say that's another example that Congress no longer sees the program as voluntary.

The Medicaid claim is slated for oral arguments on the last day of the marathon three-day session before the nine justices in March. A ruling is expected this summer.

— This post was updated at 7 p.m.

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