[NYAPRS Enews] MHW: Field Troubled By States' Challenge To ACA Medicaid Provision

[Harvey Rosenthal]

Field Troubled By States' Challenge To ACA Medicaid Provision

Mental Health Weekly  January 17, 2012

 

Twenty-six states last week have added more fuel to the fire brewing
regarding challenges to the health reform law when they filed a brief
with the Supreme Court outlining their argument that the law's Medicaid
expansion is "unconstitutional coercion" and an "infringement" on state
power.

Medicaid plays an essential role in expanding insurance coverage under
the Patient Protection and Affordable Care Act (ACA). The reform law
makes significant improvements to Medicaid including expanding the
number of people who can qualify for extensive mental health services.

The newly eligible Medicaid population includes many people with mental
health needs. Approximately one in six currently uninsured low-income
adults (those with incomes below 133 percent of the federal poverty
level) has a severe mental health disorder and many others have mental
health service needs for less severe mental health disorders, according
to a report by the Kaiser Commission on Medicaid and the Uninsured, in
April 2011.

State attorney generals and governors filed the 123-page brief with the
Supreme Court on Jan. 10. The 26 states are Alabama, Alaska, Arizona,
Colorado, Georgia, Florida, Idaho, Indiana, Iowa, Kansas, Louisiana,
Maine, Michigan, Mississippi, Nebraska, Nevada, North Dakota, Ohio,
Pennsylvania, South Carolina,  South Dakota, Texas, Utah, Washington,
Wisconsin, and Wyoming.

The Supreme Court will hear the legal challenges to the ACA in March. 

At that time, according to Re becca Farley, policy association for the
National Council for Community Behavioral Health Care (National
Council), the Medicaid expansion and three other issues will be
considered:

1) Is the individual mandate constitutional?; 

2) If the mandate is struck down, can the rest of the law stand?; and 

3) Do plaintiffs have legal standing to bring a lawsuit before the law
goes into effect?

Although the issue regarding the constitutionality of the Medicaid
expansion - which provides states with new money for Medicaid under the
conditions they cover certain new populations - was broached by states
in November, state officials had until last week to file a brief,

Farley told MHW.

Florida was the first state to initiate the lawsuit challenging the
health reform law's mandatory Medicaid-expansion requirements before
being joined by 25 other states, she said. "State officials noted in the
brief that the Medicaid expansion is unconstitutional because it
commandeers powers that have traditionally been left to the state,"
Farley said. "They feel coerced into providing coverage for these new
populations.

They're saying that because Medicaid is the single, largest source of
federal funding for states, they can't opt out of Medicaid because
states rely on it so much."

According to the Petitioners v.the U.S. Department of Health and Human
Services, et al., the ACA purports to leave states' participation in
Medicaid nominally voluntary [when] in fact, no state will be able to
reject its new terms and withdraw from the program.

The brief also noted that throughout Medicaid's history, since its
establishment in 1965, Congress has consistently "given the states
substantial discretion to choose the proper mix of amount, scope and
duration limitations on coverage, as long as care and services are
provided in 'the best interest of the recipients.'"

"The Medicaid expansion is very critical in order for individuals with
mental health and addiction needs to gain access to health care," said
Farley.

Populations that the behavioral health safety net services also
experience co-occurring disorders, chronic conditions and have a
difficult time accessing services, she said.

Medical insurance is a crucial element of expanding coverage and
improving health, Farley said. "Medicaid is a very crucial component of
that," she said.

 

Legal Arguments 'Far-Reaching'

"The arguments that Florida and the other states involved in this
lawsuit are making concerning Congress's power to enact the Medicaid
expansion are extremely troubling and far-reaching," Jennifer Mathis,
deputy legal director for the Bazelon Center for Mental Health Law, told
MHW.

If the Court were to adopt these arguments, it would have dramatic
implications for a host of laws enacted under Congress's spending power,
including child welfare, education, transportation safety, and other
laws, said Mathis.

"The same arguments that Florida makes about the Medicaid expansion
could potentially be used to invalidate laws such as No Child Left
Behind and federal foster care laws," she said. "The Supreme Court has
never adopted such a restrictive notion of Congress's spending power." *

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