By Robert Pear
The New York Times, August 8, 2011
In an unusual break with the White House, the Democratic leaders of Congress told the Supreme Court on Monday that President Obama was pursuing a misguided interpretation of federal Medicaid law that made it more difficult for low-income people to obtain health care.
Faced with severe budget problems, many states have reduced Medicaid payment rates for doctors, dentists, hospitals, pharmacies, nursing homes and other providers. In many parts of the country, payment rates are so low that Medicaid recipients have difficulty finding doctors to take them.
Federal law says Medicaid rates must be “sufficient to enlist enough providers” so that Medicaid beneficiaries have access to care to the same extent as the general population in an area.
The issue, of immense importance to poor people and states, comes to the Supreme Court in a set of cases consolidated under the name Douglas v. Independent Living Center of Southern California, No. 09-958. The court plans to hear oral arguments in October, with a decision expected by the spring. The original plaintiffs in the case, Medicaid beneficiaries and providers, say they were harmed by California’s decision to cut payment rates that were already among the lowest in the country.
The federal Medicaid law does not explicitly allow such suits. But the United States Court of Appeals for the Ninth Circuit, in San Francisco, said beneficiaries and providers could sue under the Constitution’s supremacy clause, which makes federal law “the supreme law of the land.”
The Justice Department, siding with California, told the court in May that no federal law allowed individuals to sue states to enforce this standard.
http://www.nytimes.com/2011/08/09/us/politics/09medicaid.html?_r=1&hp
Comment:
By Don McCanne, MD
President Obama’s Affordable Care Act relies heavily on the expansion of Medicaid to cover low-income individuals who are uninsured. Yet at the same time, his administration is appealing to the Supreme Court, under the supremacy clause, the federal government’s right to critically underfund the Medicaid program to the extent that patients will have significant impairment of their access to health care.
As we have stated many times in these messages, a severely underfunded welfare program for low-income individuals that clearly impairs access violates our sense of equity and health care justice. Apparently President Obama does not share this view. Otherwise, as a constitutional lawyer, why would he allow the Justice Department to take to the Supreme Court a case that would permit his administration to violate the law that says that Medicaid rates must be sufficient to enlist enough providers so that Medicaid beneficiaries have access to care to the same extent as the general population?
Where does this lead? Yesterday, in the context of reducing the deficit, he said that the country needs “modest adjustments to health care programs like Medicare.” More cuts.
Try doing that in nations with universal social insurance programs. It will never happen. But in our fragmented system, there is an opening for battles based on demographic divides. The tax-cutting, government-shrinking young rebels are taking up the cause of putting greedy geezers in their place.
Having been raised in the 40s and 50s – a time when there was great hope of an egalitarian America – I have to ask myself that trite but timely question, what kind of a country have we become?