The James Madison Institute in conjunction with Indiana state legislators and Christopher Conover have filed an amicus brief with the U.S. Supreme Court in support of Florida’s and 25 other States’ challenge to the Affordable Care Act’s (ACA) massive expansion of Medicaid that will require states to spend billions more each year on Medicaid or exit the program.
VIEW FULL BRIEF:
Brief of Amici Curiae The James Madison Institute, et al.
SUMMARY OF ARGUMENT:
“Federalism is one of the cornerstones of our constitutional system.  By reserving broad powers to the States and to the people, federalism protects liberty, enhances accountability, and fosters innovation.  The Act, however, undermines the essence of federalism by denying States a meaningful choice on whether to expand their state Medicaid programs.  States depend heavily on the hundreds of billions of dollars dispersed by the federal government through Medicaid.  Because the federal government funds at least half of each State’s Medicaid costs, no State could operate a comparable program without federal dollars, and no State could realistically decline to offer basic medical care to its neediest citizens.  Nevertheless, the Act requires States to spend tens of billions of additional dollars to expand Medicaid coverage, and threatens States with the loss of all Medicaid funding unless they comply.  Accordingly, the Act leaves States with no realistic choice but to continue to participate in Medicaid, in violation of the Tenth Amendment and the principles of federalism articulated in South Dakota v. Dole.”Moreover, because of Medicaid’s size and the Act’s all-or-nothing penalty provisions, the Act is uniquely suited for scrutiny under the coercion doctrine.  Medicaid represents far and away the largest source of federal outlays to the States, and the largest component of spending by the States.  The Act, in turn, requires States to spend tens of billions of additional dollars to expand coverage, on penalty of losing every dollar of federal Medicaid support.  These and other provisions suggest that Congress designed the Act to preclude the States from exercising a meaningful choice.  For these reasons, if the coercion doctrine is ever to have any role in protecting the principles of constitutional federalism, the Act must be deemed invalid.”
CONCLUSION:
“For these reasons, States have no meaningful choice other than to comply with the ACA.  Accordingly, the ACA is invalid under the Tenth Amendment and the principles of federalism articulated in South Dakota v. Dole.”