Equal Access for Medicaid Beneficiaries — The Supreme Court and the Douglas Cases (New Eng Jour Med)

[pinto]

Equal Access for Medicaid Beneficiaries — The Supreme Court and the Douglas Cases
Sara Rosenbaum, J.D.
November 9, 2011

http://www.nejm.org/doi/full/10.1056/NEJMp1111428?query=health-policy-and-reform

On October 3, 2011, the U.S. Supreme Court heard oral argument in the consolidated Douglas cases (Douglas v. Independent Living Center of Southern California, Douglas v. California Pharmacists Association, and Douglas v. Santa Rosa Memorial Hospital), which stemmed from lawsuits brought by Medicaid beneficiaries and health care providers against California for cutting Medicaid reimbursement rates to the point where, the plaintiffs argued, beneficiaries' access to care was seriously threatened. Although Douglas stemmed from this dispute, the central question before the Court is broader: Does the U.S. Constitution give private individuals the right to go to court to halt state actions that violate federal law and threaten immediate and irreparable injury?

A long line of decisions have treated the existence of such a right as a bedrock principle — most notably, the Court's seminal 1908 decision in Ex Parte Young, 1 which involved a constitutional challenge by corporations and shareholders to a Minnesota law that allegedly forced railroads to charge such low rates within the state that it threatened the viability of interstate commerce. In hearing the Douglas cases, the Court signaled a desire to consider this principle in the context of laws such as the Medicaid statute that Congress enacts pursuant to its power, under the Constitution's Spending Clause, to spend money for the general welfare. Douglas's resolution will thus carry implications for the entire Medicaid statute and beyond; many parts of the Medicaid law — for instance, the requirement that states furnish medical assistance to applicants and beneficiaries with reasonable promptness1 — may not create individual rights per se but nonetheless establish federal obligations for participating states. Furthermore, the ruling will affect the parts of the Affordable Care Act that establish state obligations to enact and enforce laws that make access to health insurance feasible for all people regardless of health status but do not create an individual entitlement to fair access to insurance. At the heart of Douglas is this question: Can people who are deeply affected by a federal law but don't have legal “right” under it intervene to try to prevent harms to themselves from state misconduct (and a failure of federal oversight)?

The Medicaid provision at issue is the so-called equal-access statute, enacted in 1989. Only recently has the Department of Health and Human Services (DHHS) proposed detailed standards interpreting that law, and the fate of its proposed rule is uncertain. Meanwhile, the lower courts have heard numerous challenges to states' reductions in provider payments; although they've disagreed over the law's meaning, the courts have uniformly allowed such cases to proceed. Thus, the Court's decision to hear California's claim that courts lack the power to intervene was surprising — as was the Obama administration's decision to side with the states, given that the principle embodied in Ex Parte Young has been considered inviolate. The U.S. solicitor general's struggles, during questioning, to square his position with constitutional precedents underscored the difficulties of the administration's position.

Federal Medicaid law is silent on the matter, neither expressly granting nor denying such a right of action. As Justice Sonia Sotomayor noted, the question therefore becomes what the proper “default” rule ought to be. California argued that there is no right to go to court if it's not expressly recognized by Congress and that only the DHHS can enforce Medicaid's equal-access law. But in an amicus brief, members of Congress argued that lawmakers have relied on Young and other cases, assuming the existence of a right of action.2 Indeed, they noted, the Court itself has implicitly relied on these precedents in resolving myriad disputes — most notably in a 2003 case in which the pharmaceutical industry challenged the legality of Maine's Medicaid laws under the Constitution's Supremacy Clause (which establishes federal laws' precedence over state laws).

http://www.nejm.org/doi/full/10.1056/NEJMp1111428?query=health-policy-and-reform

NEJM.org Copyright © 2011 Massachusetts Medical Society. All rights reserved.

[Demeter]

1. When you think they couldn't possibly get any more depraved

the good old American Can-Do politicians manage to outdo themselves.

[freshwest]

2. From the link: 'Justice Elena Kagan may have made the ultimate point: if the federal enforcement...

System were properly 8structured and funded,* California's proposal would have been reviewed before payments were cut.'

My emphasis with the asterisks. This is the result of a generation of GOPIGS cutting funding. Genocide in slow motion.


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