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Health Care Reform:

Health Insurance & Affordable Care Act

Supreme Court, Day 3: Can the Mandate Be Cut Out?

A Key Question Tackled on Third Day of the Health Care Hearings

‘Friend of Court’ Says Reforms Could Work Minus Mandate

Stepping into the legal ring today with the Obama administration and challengers to the law was attorney H. Bartow Farr III. The court appointed Farr as a “friend of the court” to argue that the rest of the law could stand if the mandate does not.

Invalidating the entire law, Farr said today, “is an example of the best driving out the good.”

Even without the mandate, the law “would still open the insurance market to millions of people and lower premiums for millions,” said Farr.

Medicaid Arguments

The court also listened to arguments about the law's stance on expanding Medicaid at the state level.

Although administered by the states, Medicaid is funded with both state and federal dollars, with Uncle Sam kicking in about two-thirds of the total. Clement said today that the federal government is using the states’ dependence on those federal dollars to coerce them into Medicaid expansion, with little controls over what benefits they offer.

The dollar figures at issue are enormous. Through 2016, the federal government will underwrite the entire cost of caring for Medicaid recipients who enter the program through the new eligibility requirements. The federal contribution will gradually decrease until it reaches 90% in 2020. In all, the states will receive an additional $434 billion in federal Medicaid dollars during that time.

The state officials complain that Medicaid expansion will nevertheless require them to spend at least an additional $20 billion of their own money on Medicaid, which is already a budget buster for them. Plus, they will have less control over what benefits they offer.

Justice Ruth Bader Ginsburg noted that although officials from 26 states have objected to Medicaid expansion, officials from other states welcome it.

“You are saying that because you represent a sizeable number of states, you can destroy this whole program, even though there may be as many states that want it, that don't feel coerced,” Ginsburg told Clement.

The court will issue a ruling in the case sometime before July.

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