Medicaid Expansion Unconstitutional, Doctors Argue

TUCSON, Ariz., Jan 18, 2012 /PRNewswire-USNewswire/ -- A critical method that healthcare reform will use to decrease the number of the uninsured is to force States to expand Medicaid eligibility. The U.S. Supreme Court has specifically agreed to consider arguments about the constitutionality of the Medicaid Expansion Provisions (MXPs) in the case against the Affordable Care Act (ACA or "ObamaCare") brought by Florida and 25 other States..

The government argues that MXPs aren't really coercive but are simply a condition for continued receipt of Medicaid funding. States could simply withdraw from Medicaid and lose the entirety of their federal funding for indigent medical care—while their citizens continue to pay federal taxes to fund Medicaid in other States.

The Association of American Physicians and Surgeons (AAPS) argues in an amicus brief filed Jan 17 that such a Hobson's choice is no choice at all. "Regardless of the choice each State makes, that State's spending will increase." The State's taxpayers will be burdened to pay for the increase without an affirmative decision of its legislature and governor, but by federal fiat. Thus, the MXPs are "an assault on the sovereignty of the States and the rights of their citizens."

Many States are in a precarious fiscal situation, and according to the U.S. Government Accountability Office (GAO), "the primary driver of the fiscal pressure confronting the state and local sector is the continued growth in health-related costs."

"Our nation cannot plunder the treasuries of its political subdivisions…without putting the existence of the States in jeopardy," writes AAPS.

The onerous burdens that the MXPs lay on the States continue into the indefinite future. In effect, the MXPs place federal and State spending on "auto pilot" beyond the end of the term of this Congress, thus withholding legislative power from future Congresses and veto power from future Presidents.

Additionally, directing States to spend money in particular ways is not among the Constitutionally enumerated powers of Congress.

If the MXPs are unconstitutional, then the ACA must be declared unconstitutional in its entirety, AAPS argues, citing AAPS's separate amicus brief filed on Jan 6 http://www.aapsonline.org/fl-v-hhs-amicus-01-06-2012.pdf on the issue of severability. "Severance, in the absence of a severability clause, wreaks havoc on the Constitution's system of checks and balances and ignores the Separation of Powers doctrine," states the AAPS brief.

The brief on the Medicaid provisions is available online http://www.aapsonline.org/fl-v-hhs-amicus-01-17-2012.pdf.

AAPS, a national organization of physicians in all specialties, was founded in 1943 to preserve and promote the practice of private medicine and the sanctity of the patient-physician relationship.

SOURCE Association of American Physicians and Surgeons (AAPS)