Medicaid Expansion I NFIB v Sebelius Constitutionality of Medicaid Expansion under the Affordable Care Act Constitutionality of Expansion Supreme Court holds in NFIB v Sebelius Medicaid expansion violates Congress spending power as unconstitutionally coercive of states beca ID: 622641
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Slide1
Affordable Care Act: Medicaid ExpansionSlide2
Medicaid Expansion
I.
NFIB v. Sebelius
: Constitutionality of Medicaid Expansion under the Affordable Care Act
Slide3
Constitutionality of Expansion
Supreme Court holds in
NFIB v. Sebelius
:
Medicaid expansion violates Congress’ spending power as unconstitutionally coercive of states because:
1. States not given adequate
notice to voluntarily consent to
expansion,
and
2. HSS Secretary could potentially withhold all of a state’s existing federal Medicaid funds for non-complianceSlide4
Constitutionality of Expansion
Medicaid Expansion is a
“gun to the head”
because the “threatened loss of over 10 percent of a state’s overall budget….is economic dragooning that leaves the states with
no real option but to acquiesce
.”
-
Sebelius
, at 54. Slide5
Constitutionality of Expansion
Coercive But.........
Supreme Court fashions a
“remedy”
to overcome the coercionSlide6
Constitutionality of Expansion
Supreme Court’s remedy for coercion:
Remedy is to limit HHS Secretary’s power to withhold existing federal Medicaid funds for state non-compliance with Medicaid expansion
Makes Medicaid expansion optional for statesSlide7
Supreme Court on ACA’s Medicaid Expansion
Issue
Vote
Support
Oppose
The ACA’s Medicaid Expansion
is Unconstitutionally Coercive
7:2
Roberts, Breyer, Kagan,
Scalia, Kennedy, Thomas, Alito
Ginsburg, Sotomayor
The Secretary’s enforcement authority should
be limited
5:4
Roberts, Breyer, Kagan,
Ginsburg, Sotomayor
N/A
The entire ACA should be invalidated
4:5
Scalia,
Kennedy, Thomas, Alito
Roberts, Breyer, Kagan,
Ginsburg, SotomayorSlide8
Medicaid Expansion
I.
NFIB v. Sebelius
: Constitutionality of Medicaid Expansion under the Affordable Care Act
II. Past, Present, and Future: A glimpse at Medicaid Establishment and ExpansionSlide9
Past: Establishment of MedicaidSlide10
Past: Medicaid Establishment
Establishment of Medicaid
Established in 1965 as a jointly funded cooperative between federal and state governments
Purpose
: Provide medical benefits to those who have either no or inadequate medical insurance
Program requirements
: Established by each state and eligibility varies per stateSlide11
Past: Medicaid Establishment
Tennessee’s Response to Medicaid Enactment
Established TennCare in 1994
Serves roughly 18-19% of the state’s population
Two types of TennCare:
TennCare Medicaid
and
TennCare StandardSlide12
Past: Medicaid Establishment
For:
Tennesseans who are eligible for Medicaid
Groups covered include: Children under 21, pregnant women, single parents of minor child, elderly, and disabled
Income limits are applicable
For:
Children under 19 who are already enrolled in TennCare Medicaid
AND
Lack access to group health insurance
OR
Time of eligibility for TennCare Medicaid is ending and they no longer qualify
TennCare Medicaid
TennCare StandardSlide13
Present: Tennessee without Medicaid ExpansionSlide14
Present: Tennessee without Medicaid Expansion
Current source of Tennesseans HealthCare coverage
Location
Employer
Individual
Medicaid
Medicare
Other Public
Uninsured
Total
TN
47%
5%
18%
14%
2%
14%
100%Slide15
Present: Tennessee without Medicaid Expansion
Tennessee Compared to United StatesSlide16
Future: Medicaid Expansion
Affordable Care Act gives states the option to expand Medicaid coverage to nonelderly adults with incomes up to 138% of the federal poverty level (FPL)Slide17
Future: Medicaid ExpansionSlide18
Future: Medicaid Expansion
Means that Tennessee can extend TennCare coverage to individuals up to 138% FPL
Persons in household
Poverty Guideline
133%
138%
400%
1
$11,490
$15,282
$15,856
$45,960
2
$15,510
$20,628
$21,404
$62,040
3
$19,530
$25,975
$26,952
$78,120
4
$23,550
$31,322
$32,500
$94,200Slide19
Future: Medicaid Expansion
No deadline by which states must decide whether to expand or not
No partial expansion-
all
or
nothing
Effects of expansionSlide20
Future: Medicaid Expansion
Effects of Expansion
Effect on people below 100% FPLSlide21
Future: Medicaid Expansion
Effects of ExpansionSlide22
Future: Medicaid Expansion
Effects of Expansion
Effect on people below 100% FPL
Financial Effects of ExpansionSlide23
Financial Effects of Expansion
100% for first three years (2014, 2015, 2016)
95% in 2017
94% in 2018
93% in 2019
90% thereafter
Approx. $31 million in 2017
Approx. $95 million in 2019
Federal Government will pay
Tennessee’s Increased CostsSlide24
Future: Medicaid Expansion
Effects of Expansion
Effect on people below 100% FPL
Financial Effects of Expansion
Effects of the Eligible but not Enrolled (EBNE)Slide25
Effects of the EBNE
Individuals who are currently eligible for Medicaid but not enrolled will likely go to exchanges and be automatically moved to TennCare
State will pay approximately 35% of the cost of covering this group
“Woodwork effect”
May be over 60,000 EBNE individuals who enroll in TennCareSlide26
Future: Medicaid Expansion
Effects of Expansion
Effect on people below 100% FPL
Financial Effects of Expansion
Effects of the Eligible but not Enrolled (EBNE)
Effects on healthcare availability Slide27
Effects on Healthcare Availability
More than 220,000 (and possibly up to 370,000) additional Tennesseans who are not currently eligible for TennCare would become eligible if expanded
Expansion would result in 24.7% reduction in overall number of uninsured in TennesseeSlide28
Where do States stand on Expansion?
Future: Medicaid ExpansionSlide29
Where do states stand?Slide30
Medicaid Expansion?