The Expanded Medicaid Mandate: Federal Power, Contract Principles, and Coercion, Slides of Management Fundamentals

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T

HE

E

XPANDED

M

EDICAID

M

ANDATE

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The

Expanded

Medicaid

Mandate

The

Spending

Power

Very

broad

federal

power

to

attach

conditions

to

cooperative

federalism

programs

[

South

Dakota

v.

Dole

]

Only

two

significant

constraints

on

Federal

Government

to

attach

conditions

to

spending

programs

Federal

Government

must

state

conditions

on

federal

program

unambiguously

in

the

statute

when

the

grant

of

federal

funds

is

made

Conditions

on

federal

grant

invalid

if

they

cross

the

line

by

going

beyond

“pressure”

to

“coercion”

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The

Expanded

Medicaid

Mandate

Clear Statement Considerations

PPACA’s expanded Medicaid mandate clearly states what obligations a state incurs under modified Medicaid - Is that sufficient, or (given concerns about state autonomy and “lock

in”) must there be a consideration of clear statement concerns when a state originally signs up for an ongoing, relational program such as Medicaid?

Foreseeability issue

e.g. ,^ moving benefits well beyond the poverty ‐ level eligibility when Medicaid originally was founded and was linked to categorical eligibility under existing public assistance programs (AFDC) - Concerns about bait and switch - the displacement of political accountability (the Medicaid history of interaction between state and federal governments) - Protecting the integrity of a state’s political process - Other claimants for state funds - Concerns about the role of money from external sources in influencing a state’s political process ( e.g. ,^ limits on campaign contributions and expenditures) 31 Docsity.com

The

Expanded

Medicaid

Mandate

Coercion

Amorphous term in this context

hard to define - No court has invalidated a federal spending program on grounds of coercion in over 75 years - But the category exists - and one might ask whether it can exist if the expanded Medicaid mandate of PPACA does not fit inside - Different ways of viewing “coercion” - Process ‐ focused concepts of coercion - e.g. , forced confessions, personal threats or duress in contracting or wills - Choice ‐ set coercion - e.g. , forcing inappropriate choices - Choice ‐ set coercion - Lee v. Weisman (Establishment Clause) 32 Docsity.com

The

Expanded

Medicaid

Mandate

Remedy

Restore integrity of political process - Where a substantial modification of an ongoing federal spending program such as Medicaid occurs and affects a substantial portion of a state’s budget (as in Medicaid), the Federal Government may not use its leverage to impose the new conditions as a program modification 34 Docsity.com

The

Expanded

Medicaid

Mandate

Remedy

Options available to Federal Government

Allow states to accept or reject the newly imposed conditions - Where the Federal Government is unwilling to continue a program in existence under the pre

existing terms, the Federal Government must rescind the entire program and take the political responsibility for so doing

States should not have to opt out of the pre

existing program, but instead the Federal Government should be required to terminate the pre

existing program

States would have an opportunity, as an original matter, to opt into the modified program (rather than having to opt out, as is now the case under

PPACA)

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