When Pressure Becomes Compulsion–the ACA & Medicaid Funding

As this blog is being written, oral arguments are being held at the 11th Circuit Court of Appeals in Atlanta on the Affordable Care Act. Many of us are familiar with the most controversial part of the law, the health insurance mandate.  However, there are other parts of the ACA that are also being challenged.  One example is whether Congress is allowed to cut Medicaid funding to states that do not expand their Medicaid programs according to the ACA.

In its brief, attorneys for the states made the following argument:

The Supreme Court has repeatedly assured States and federal courts that there are outer limits on the federal spending power and that there is a point where federal spending programs become ―so coercive as to pass the point at which pressure turns into compulsion. South Dakota v. Dole, 483 U.S. 203, 211 (1987) (quoting Steward Mach. Co. v. Davis, 301 U.S. 548, 590 (1937)). Without such a limit, the federal spending power threatens the entire constitutional structure — Congress can commandeer the States to any degree or impose any command that does not violate an affirmative constitutional prohibition by the simple expedient of attaching it to a pre-existing pool of federal money too large to decline.

The states lost on this argument at the District Court level.  Judge Vinson ruled that because Medicaid was a voluntary program, there was no compulsion.

An interesting article in yesterday’s Wall Street Journal (by Richard A. Epstein & Mario Loyola) also argues that the Medicaid provisions in the ACA should be stricken:

And yet the government is comparing this Medicaid requirement to a “voluntary” contract.  Does anyone believe that a person is entitled “voluntarily” to continue his journey so long as he pays for all poor people who use the roads?  The government’s action is plainly coercive because it necessarily conditions the exercise of one right upon the conscious surrender of a second….The constant backdrop of the federal taxing power makes a mockery of the claim that state participation under ObamaCare is voluntary.  The only way to prevent this grave intrusion on state autonomy is to strike down the Medicaid provisions of the health-reform law.

The question we are left to answer is at what point does pressure turn into compulsion?


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