How does Medicaid factor into the case?

By McClatchy Newspapers  • 

WASHINGTON — Although most of the debate over the Affordable Care Act has focused on its rule that all Americans have health insurance, the Supreme Court will consider today a states’-rights challenge to the law’s expansion of the Medicaid program.

Q: What is at issue in the Medicaid part of the case?

A: Whether the states can be required to offer subsidized health care to 17 million more low-income people.

Begun in 1965, the Medicaid program offers money to the states, which in turn contribute their own money. States need not participate, but all of them do. On average, the federal government pays 57 percent of the cost. Having grown steadily for decades, Medicaid in 2008 served about 47 million people, most of them mothers and children.

Q: So what’s new in the Affordable Care Act?

A: It says states must do more and provide health care for all those whose income is below 138 percent of the poverty line. However, the federal government will pay nearly all the added cost. Its share will be 100 percent in 2014 and drop to 90 percent by 2020.

Q: Why do 26 states object if the federal government is paying the tab?

A: They say they will be forced to spend at least $20 billion more in this decade, and they say they have “no choice” but to go along. Otherwise, they could lose all their Medicaid money, a devastating blow to state budgets. They say this amounts to unconstitutional “coercion” of the sovereign states.

Q: How has the Supreme Court dealt with such suits in the past?

A: The justices have never struck down a federal spending law on the ground that it pressures states to go along. For decades, Washington has sent money to states for purposes such as education, transportation and health care, but it has required states to follow the federal rules.