The Medicaid Conflict: Federal and State

Currently there is a heated debate that has been brewing between the federal government and the states over the implementation of the Medicaid expansion that is set to begin in 2014. The recent ruling of the Supreme Court gave the states freedom to opt out of implementing the expansion. The Medicaid expansion stands as an example of why the Constitutional Framework of Federalism is vital in defining boundaries that often seem blurred, between the federal government and the states. The Medicaid expansion is attached to the Patient Protection and Affordable Care Act that is set to take effect January 1, 2014.

It is aimed at including additional uninsured people into the Medicaid program, particularly adults ages 19-65. On June 28, 2012 the Supreme Court ruled the Medicaid expansion was unconstitutional. According to the 10th Amendment of the United States Constitution, “…powers not granted to the United States were reserved to the States or to the people. ” (Cornell University Law School, n. d. ). The constitutional framework of federalism limits the power in which the federal government has over the states.

The government is only allowed to give extra funding as an incentive to the participating states, but not to punish and remove funding from those that do not. It would also not be permitted under the Commerce Clause that states, “national government can regulate various activities so long as they bear on interstate commerce. ” (Levin-Waldman, 2012). The Supreme Court deemed it was unconstitutional for the federal government to withhold Medicaid funding for the states that did not elect to participate thus creating an unfair financial strain on the states.

As a result of the ruling, the States now have the option to reject participation in the Medicaid expansion without fear of losing the funding they are currently receiving. (Drummond-Dye, 2012). Currently as of July 2013, there are 28 states that plan to participate in the Medicaid Expansion. There are also five states that are leaning towards participating, 17 states that will not participate, and 7 states that are leaning towards not participating. (Obamacare Facts, n. d. ). This is a slight change from June, 2013, where

there were 26 states planning to participate, 1 leaning on participating, 13 states that will not participate, and 6 states that are leaning on not participating. (The Advisory Board Company, 2013). The Medicaid expansion was intended to widen the eligibility requirements for more applicants in the struggle to provide healthcare for the millions of uninsured across the country. In doing this, an additional seventeen million will become eligible at the start of the expansion. (Richardson, 2013). After putting into effect the Medicaid expansion program in 2014, the federal government would begin by covering 100% until 2016.

In the subsequent years, the federal government will reduce that percentage to 90% by the target date of 2016. The effectiveness of a policy is the end result of whether it achieves its intended goal. In the situation of the Medicaid expansion, the intentional goal has already met with resistance. At this time, the intended amount of people that will receive healthcare under the Medicaid expansion will not be reached. Another source of resistance within the country is the growing number of doctors or medical establishments that are discontinuing accepting Medicaid patients.

The question still remains of will the reformation of the Medicaid system be a success? The complete total effectiveness of the policy will depend on the level of participation from each state. As previously mentioned, not all states are actively participating and electing instead to opt out of the expansion. One of the reasons some states will opt out is because they are financially struggling to pay for the Medicaid program they currently have in place. Rather than participating in the Medicaid expansion, the states might look to expand on their current Medicaid program or even an alternative to the expansion.

Another reason for opting out is the amount of people that already qualify for Medicaid that do not have it now but might sign up to receive Medicaid benefits after the new implementation. The federal government will not cover these people and the states will be stuck with the cost. This could prove to be too heavy of a burden for some states as they are already paying 50-75% on the current Medicaid program. (Carroll, 2012). For the states that are electing to participate in the expansion program, they are instead choosing to focus on providing healthcare to the many uninsured citizens within their state.

The aim of the federal government is to make available healthcare to people who would not be eligible under the prior Medicaid requirements. Without instilling the Medicaid expansion within the states, the numbers of people would remain uninsured and without healthcare. The Medicaid expansion is set to start in 2014 and will be funded by the federal government 100% to every state that is participating throughout the startup period. As a result of the expansion, more adults will be able to receive healthcare they were previously not able to obtain.

In trying to formulate a more systematic healthcare for the nation, it faces the challenge of the varying Medicaid eligibility each state has. Another challenge in producing a uniform system is that states with higher levels of poverty will have a higher percentage of additional participants within the Medicaid expansion program. The states with a lower levels of poverty will have a lower percentage of additional participants. The final negative factor in the expansion might be if a state opts in but later decides to back out or if the federal funding stops.

The Supreme Court ruling does not make previsions for that situation and states run the risk of losing total funding for their Medicaid program. One of the trustees that was appointed by President Barack Obama gave a warning to the states he or she felt it was a “near certainty” government support would likely be cut in the future. (Ingram, 2013). If this were to become a reality, would the states be able to carry the financial weight on their backs without collapsing? My answer would be most likely no. Each state must weigh on all the mentioned factors before deciding what is financially in the best interest for them now and in the future.

After reviewing all the facts involved with the Medicaid expansion, there seems to be much tension between the federal government and the states as a result of “blurred lines” within their respective powers. To be more effective, perhaps there should be another agreement between the two, one that would benefit everyone involved. The Constitutional Framework of Federalism exists to ensure the federal government and the states work together to accomplish what is in the best interest of the people, nationally and locally. References Carroll, A. (July, 2012). Why Medicaid expansion is key part of health reform. CNN Opinion.

Retrieved from http://www. cnn. com/2012/07/05/opinion/carroll-medicaid-expansion Cornell University Law School. (n. d. ). Tenth Amendment. Retrieved from http://www. law. cornell. edu/constitution/tenth_amendment Drummond-Dye, R. (2012). Medicaid Expansion and Physical Therapy… …The Supreme Court has spoken. What’s next? By. PT In Motion, 4(9), 45-47. FamiliesUSA. (Aug, 2012). A Closer Look: The Supreme Court’s Health Care Decision. Retrieved from http://familiesusa2. org/assets/pdfs/health-reform/Closer-Look-at-Court-ACA-Decision. pdf Ingram, J. (May, 2013). ObamaCare’s Medicaid expansion bill wrong for Illinois.

Illinois Policy Institute. Retrieved from http://www. illinoispolicy. org/blog/blog. asp? ArticleSource=5873 Levin-Waldman, O. M. (2012). American government. San Diego, CA: Bridgepoint Education, Inc. OBAMACARE FACTS. (n. d. ). ObamaCare Medicaid Expansion. Retrieved from http://obamacarefacts. com/obamacares-medicaid-expansion. php RICHARDSON, L. E. , & YILMAZER, T. (2013). Understanding the Impact of Health Reform on the States: Expansion of Coverage. The Advisory Board Company. (June, 2013). Where each state stands on ACA’s Medicaid expansion. Retrieved from http://www. advisory. com/Daily-Briefing/2012/11/09/MedicaidMap#lightbox/0/.