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The legal implications of the expanded medicaid mandate under the spending power, focusing on contract principles, clear statement considerations, and coercion. It discusses the ongoing federal-state relationship, the 'lock-in' problem, and the role of fairness and reasonableness in contract modifications. The document also examines the concerns of clear statement, coercion, and the potential remedies for states.
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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
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
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
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
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