NHeLP Files Amicus Brief in Support of Health Reform Law on Behalf of the Ameri

Case No. 3:10-cv-91-RV/EMT 
State of Florida, by and through Bill McCollum, Attorney General of the State of Florida, et al., Plaintiffs, 
United States Department of Health and Human Services, et al.,  Defendants. 

Amici organizations are not publicly held companies. None have parent corporations, except for Florida Alliance for Retired Americans (FLARA) and SEIU HealthCare Local which are affiliates of non profit corporations.1
Count Four of the Amended Complaint challenges provisions of the Patient Protection and Affordable Care Act (ACA) that expand Medicaid to childless, non-disabled adults whose incomes are below 133% of the federal poverty level. Am. Compl. at ¶¶ 55-57. According to the Plaintiffs, these provisions convert Medicaid into a ?federally-imposed universal healthcare regime? that they have no choice but to accept.2 The Plaintiffs? ?coercion and commandeering? claim is not that Medicaid itself is unconstitutional, but that the ACA works such a transformation that the States must spend money and provide services in ways that are ?radically changed? from what was required by the Medicaid Act on the day before the ACA was enacted. Memorandum in Support of Plaintiffs? Motion for Summary Judgment (Plfs. Mem.) at 25. 3

As discussed below, the coercion and commandeering claim finds no support in the history and structure of the Medicaid Act, as originally enacted or as Congress and the States have changed it over time. 
Medicaid is part of the Social Security Act, enacted pursuant to Congress?s Spending Clause authority. See 42 U.S.C. §§ 1396-1396w-1. From the time it was enacted, Medicaid has conditioned federal funding on States? agreements to comply with a series of mandates. The Supreme Court has consistently recognized Congress?s broad authority to enact such legislation pursuant to the Spending Clause. In South Dakota v. Dole, the Court held that cooperativefederalism programs such as Medicaid, where States accept Federal money together with Federal conditions for how that money may be used, are constitutional. 483 U.S. 203 (1987). See also, e.g., Okla. v. Civil Serv. Comm?n, 330 U.S. 127 (1947) (affirming Congress?s broad power to set conditions for the receipt of Federal funds); Steward Mach. Co. v. Davis, 301 U.S. 548 (1937) (affirming Congress?s authority under taxing and spending clauses to enact Social Security Act);Sabri v. United States, 541 U.S. 600 (2004) (unanimously reaffirming broad scope of Congress?s spending power); cf. Harris v. McRae, 448 U.S. 297 (1980) (holding Congress?s ability to refuse to provide Medicaid funds necessarily involves the ability to subsidize only certain procedures and to exclude even medically necessary abortions from those covered procedures).

I. The Affordable Care Act Does Not Radically Change Medicaid?s Structure or Purpose.
A. Medicaid?s Core Framework
Medicaid was added to the Social Security Act in 1965 as Title XIX. Congress invited States to accept significant Federal funding?half or more of State expenditures?in return for providing coverage for specific groups of people (additional groups at State option) for a specific set of services (additional services at State option). Since 1965, Congress has amended Medicaid on numerous occasions. Whenever these changes have occurred, including those in the ACA, they have not altered the program?s essential framework. 

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