As politicians, attorneys, and analysts across the political spectrum study Judge Roger Vinson’s ruling striking down President Obama’s health-care legislation, one critically important question presents itself: Does it block the current implementation of Obamacare?
The question matters because millions of American families, employers, insurers, and medical providers are already adjusting their financial plans and health-care arrangements in the expectation that Obamacare’s various provisions will go into effect as originally scheduled. The question also matters because of the fiscal crisis facing most state governments around the country. Legislatures are convening their 2011 sessions, new governors are setting up their administrations, and they need to know ASAP if Obamacare’s Medicaid provisions still have the force of law.
While the individual mandate to enroll in private health plans has gotten the lion’s share of attention — and is the reason Judge Vinson struck the law down yesterday — the most significant part of the Obamacare bill was a vast expansion of Medicaid. It accounts for the majority of expected reduction in the ranks of the uninsured, and will cost taxpayers dearly. Although the mandatory increase in the Medicaid caseload is still years in the future, the bill has been interpreted as preventing states from tightening their eligibility requirements even now. States facing a collective budget deficit for the coming year of well over $100 billion need the flexibility to seek cost savings in their Medicaid programs, flexibility that Obamacare severely constricts.
In fact, the reason why more than two dozen states are parties to the Florida lawsuit is that they argued the Obamacare bill was an unconstitutional coercion of state governments to carry out federal dictates. Vinson actually rejected this claim in his decision, but because he also rejected severability the Medicaid provisions cannot stand. Vinson also rejected the need to issue an injunction ordering the federal government to stop implementing Obamacare, viewing it as unnecessary because federal officials can’t enforce an unconstitutional law. Some see his decision as blocking implementation. Some don’t.
State officials need clarification immediately. It could come from the court or from Congress. But it can’t come soon enough.