affordable care act: medicaid expansion. medicaid expansion i.nfib v. sebelius: constitutionality of...
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Affordable Care Act: Medicaid Expansion
Medicaid Expansion
I. NFIB v. Sebelius: Constitutionality of Medicaid Expansion under the Affordable Care Act
Constitutionality of Expansion
Supreme Court holds in NFIB v. Sebelius:
Medicaid expansion violates Congress’ spending power as unconstitutionally coercive of states because:
1. States not given adequate notice to voluntarily consent to expansion, and2. HSS Secretary could potentially withhold all of a
state’s existing federal Medicaid funds for non-compliance
Constitutionality of Expansion
Medicaid Expansion is a “gun to the head” because the “threatened loss of over 10 percent of a state’s overall budget….is economic dragooning that leaves the states with no real option but to acquiesce.”
- Sebelius, at 54.
Constitutionality of Expansion
Coercive But.........
Supreme Court fashions a “remedy” to overcome the coercion
Constitutionality of Expansion
Supreme Court’s remedy for coercion:
Remedy is to limit HHS Secretary’s power to withhold existing federal Medicaid funds for state non-compliance with Medicaid expansion
Makes Medicaid expansion optional for states
Supreme Court on ACA’s Medicaid Expansion
Issue Vote
Support Oppose
The ACA’s Medicaid Expansion is Unconstitutionally Coercive
7:2 Roberts, Breyer, Kagan, Scalia, Kennedy, Thomas, Alito
Ginsburg, Sotomayor
The Secretary’s enforcement authority should be limited
5:4 Roberts, Breyer, Kagan, Ginsburg, Sotomayor
N/A
The entire ACA should be invalidated
4:5 Scalia, Kennedy, Thomas, Alito
Roberts, Breyer, Kagan, Ginsburg, Sotomayor
Medicaid Expansion
I. NFIB v. Sebelius: Constitutionality of Medicaid Expansion under the Affordable Care Act
II. Past, Present, and Future: A glimpse at Medicaid Establishment and Expansion
Past: Establishment of Medicaid
Past: Medicaid Establishment
Establishment of Medicaid
Established in 1965 as a jointly funded cooperative between federal and state governments
Purpose: Provide medical benefits to those who have either no or inadequate medical insurance
Program requirements: Established by each state and eligibility varies per state
Past: Medicaid Establishment
Tennessee’s Response to Medicaid Enactment
Established TennCare in 1994 Serves roughly 18-19% of the
state’s population Two types of TennCare:
TennCare Medicaid and TennCare Standard
Past: Medicaid Establishment
For: Tennesseans who are
eligible for Medicaid Groups covered include:
Children under 21, pregnant women, single parents of minor child, elderly, and disabled
Income limits are applicable
For: Children under 19 who
are already enrolled in TennCare Medicaid AND
Lack access to group health insurance OR
Time of eligibility for TennCare Medicaid is ending and they no longer qualify
TennCare Medicaid TennCare Standard
Present: Tennessee without Medicaid Expansion
Present: Tennessee without Medicaid Expansion
Current source of Tennesseans HealthCare coverage
Location
Employer
Individual
Medicaid
Medicare
Other Public
Uninsured
Total
TN 47% 5% 18% 14% 2% 14% 100%
Present: Tennessee without Medicaid Expansion
Tennessee Compared to United States
Future: Medicaid Expansion
Affordable Care Act gives states the option to expand Medicaid coverage to nonelderly adults with incomes up to 138% of the federal poverty level (FPL)
Future: Medicaid Expansion
Future: Medicaid Expansion
Means that Tennessee can extend TennCare coverage to individuals up to 138% FPL
Persons in household
Poverty Guideline
133% 138% 400%
1 $11,490 $15,282 $15,856 $45,960
2 $15,510 $20,628 $21,404 $62,040
3 $19,530 $25,975 $26,952 $78,120
4 $23,550 $31,322 $32,500 $94,200
Future: Medicaid Expansion
No deadline by which states must decide whether to expand or not
No partial expansion- all or nothing Effects of expansion
Future: Medicaid Expansion
Effects of Expansion
Effect on people below 100% FPL
Future: Medicaid Expansion
Effects of Expansion
Future: Medicaid Expansion
Effects of Expansion
Effect on people below 100% FPL
Financial Effects of Expansion
Financial Effects of Expansion
100% for first three years (2014, 2015, 2016)
95% in 2017 94% in 2018 93% in 2019 90% thereafter
Approx. $31 million in 2017
Approx. $95 million in 2019
Federal Government will pay
Tennessee’s Increased Costs
Future: Medicaid Expansion
Effects of Expansion
Effect on people below 100% FPL
Financial Effects of Expansion Effects of the Eligible but not
Enrolled (EBNE)
Effects of the EBNE
Individuals who are currently eligible for Medicaid but not enrolled will likely go to exchanges and be automatically moved to TennCare
State will pay approximately 35% of the cost of covering this group
“Woodwork effect” May be over 60,000 EBNE individuals
who enroll in TennCare
Future: Medicaid Expansion
Effects of Expansion
Effect on people below 100% FPL
Financial Effects of Expansion Effects of the Eligible but not
Enrolled (EBNE) Effects on healthcare
availability
Effects on Healthcare Availability More than 220,000 (and possibly up to
370,000) additional Tennesseans who are not currently eligible for TennCare would become eligible if expanded
Expansion would result in 24.7% reduction in overall number of uninsured in Tennessee
Where do States stand on Expansion?
Future: Medicaid Expansion
Where do states stand?
Medicaid Expansion?