ACA in The Supreme Court – The Closing Arguments

Author: Marc L. Penchansky

Yesterday, the Supreme Court of the United States heard the final two arguments concerning the Affordable Care Act (“ACA” or “Act”). The day’s first argument concerned whether the remaining provisions of the Act could stand if the Supreme Court ruled that the mandate was unconstitutional. For more information on that argument, click here. The final argument concerned the extension of Medicaid benefits codified in the Act.

Medicaid is a cooperative program between the federal government and the States where the Federal government shares the costs of providing health care to the indigent with the States. In exchange, the States agree to comply with the requirements of the Medicaid Act and its implementing regulations. In an effort to insure as many Americans as possible, the ACA extended Medicaid coverage beginning in 2014 to individuals with incomes up to 133% of the poverty level. 42 U.S.C. § 1396a(A)(10)(a)(i)(VIII). It is estimated that this extension would lead to an additional 16 million people on Medicaid. For the first three years, the federal government must pay all of the additional costs. In 2017, the federal government’s share is lowered to 95%, and over the next two years the federal share diminishes one percent per annum. In 2020, the allocation becomes fixed at 90% paid by the federal government and 10 % paid by the States. 42 U.S.C. § 1396d(y). This level of federal support far exceeds the typical federal contribution rate of 50% to 83%. See 42 U.S.C. 1396(b); Government’s Brief at p. 9.

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