NFIB v. Sebelius; Florida v. HHS (Medicaid expansion issue)
Issue: Does the Affordable Care Act’s (ACA) Medicaid expansion violate Congress’s spending clause power?
Background: As part of Congress’ goal of expanding access to affordable health insurance, the ACA required states that choose to participate in Medicaid to cover nearly all non-elderly adults up to 138% of the federal poverty level, beginning in 2014. Congress provided 100% federal funding for the expansion for 2014-2016, with federal funding gradually reducing to 90% in 2020 and thereafter. A group of states led by Florida challenged the ACA’s Medicaid expansion. The Supreme Court held that the Medicaid expansion was unconstitutionally coercive because states lacked adequate notice to voluntarily consent and the Secretary could potentially withhold all of a state’s federal Medicaid funds for non-compliance. The Court also held that this issue was remedied by limiting the Secretary’s enforcement authority so that states that did not adopt Medicaid expansion only lost federal Medicaid expansion funds.
Current Status: Final decision issued
U.S. Supreme Court Amicus Brief (Medicaid Expansion Issue), Feb. 17, 2012
Amici: Prescription Policy Choices, and 58 health law and policy scholars
Argument Summary: Congress has exercised its spending power in a clearly constitutional manner, consistent with existing precedent. The ACA’s Medicaid expansion is not constitutionally coercive of states.
Outside Counsel: Michael Kevin Outterson, Boston University School of Law
Related Resources:
Rosenbaum S. National Federation of Independent Business v. Sebelius and the Medicaid Aftermath. Public Administration Review. May 13, 2013. https://doi.org/10.1111/puar.12079
Sunkara V, Rosenbaum S. The Constitution and the Public’s Health: The Consequences of the US Supreme Court’s Medicaid Decision in NFIB v Sebelius. Public Health Reports. October 13, 2016. https://doi.org/10.1177/0033354916670
Rosenbaum S, Wilensky G. Closing the Medicaid Coverage Gap: Options for Reform. Health Affairs. March 2, 2020. https://doi.org/10.1377/hlthaff.2019.01463
Rosenbaum S. Confronting the Consequences of National Federation of Independent Business v Sebelius to Insure the Poor. The Milbank Quarterly. April 13, 2021. https://www.milbank.org/quarterly/opinions/confronting-the-consequences-of-national-federation-of-independent-business-v-sebelius-to-insure-the-poor/