Amicus brief: Florida v. DHHS

Executive Summary

This amicus brief argues that the ACA's Medicaid expansion is constitutional

In the Supreme Court of the United States
STATE OF FLORIDA, ET AL., Petitioners,
Whether the Eleventh Circuit Court of Appeals properly held that the Medicaid expansion provisions of the Patient Protection and Affordable Care Act do not impermissibly coerce Petitioner States into continuing their participation in the Federal-State cooperative Medicaid partnership.


For more than four decades, Congress and the States have chosen to help lower-income people get the health care they need through Medicaid programs. Amici are health care provider and consumer organizations that have worked extensively with Medicaid programs. While each Amicus has particular interests, they collectively bring to the Court an indepth understanding of how the Medicaid Act has been amended and implemented over time, at both the national and state levels. The amici want to bring accurate information about Medicaid?s structure and history to the Court as it considers the constitutionality of the Patient Protection and Affordable Care Act (ACA) Medicaid expansion.


Beginning in January 2014, the ACA requires participating States to expand their Medicaid programs to include certain non-disabled, non-elderly individuals whose incomes are below 133% of the Federal poverty level ($14,856 for an individual in the contiguous U.S. in 2012). Contrary to Petitioner States? assertions, this expansion does not represent ?an extreme and unprecedented abuse of Congress? spending power,? nor does it ?revolutionize? Medicaid or leave States with ?no choice but to continue to participate in Medicaid.? Pet. Br. at 23, 34, 18.

The Petitioners? coercion claim is not supported by either the history or the structure of the Medicaid Act, as it was originally enacted or as Congress and the States have changed it over time. In exchange for Federal funding, participating States have always been required to provide a minimum package of benefits to certain population groups?with options to do more. Over time, as social conditions and national interests have changed, the mandates and options have changed. The ACA expansion is part and parcel of this structure.

As with previous Medicaid Act amendments, the ACA expansion neither forces States to participate in Medicaid nor forces individuals to enroll in Medicaid. Medicaid is, and always has been, voluntary for both States and individuals. Since its inception, the Medicaid ?deal? has always been attractive to States?generally offering States from 50% to 83% Federal funding and sometimes 100% Federal funding. The ACA?s generous Federal funding offer?100% initially and 90% thereafter?neatly reflects this Medicaid feature.
Over the years, Congress has used ?maintenance of effort? requirements to assure program stability during transition periods, and the Federal agency administering Medicaid has always had the authority to deny all or partial Federal funding to a State that fails to adhere to the statutory minimums. Legally, there is nothing about the ACA Medicaid expansion that departs from past precedent.

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