09 Aug

Democrats Challenging Administration on Medicaid


The McGlynn: Right on! This was on the back pages of today’s NYT. It belongs on the frontpage of every damn so-called newspaper in our country.

WASHINGTON — 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.

The Democratic leaders said Medicaid beneficiaries must be allowed to file suit to enforce their right to care — and to challenge Medicaid cuts being made by states around the country.

The Obama administration maintains that beneficiaries and health care providers cannot sue state officials to challenge cuts in Medicaid payment rates, even if such cuts compromise access to care for the poor.

In a friend-of-the-court brief, the lawmakers said the administration’s position “would undermine the effectiveness of Medicaid.” In addition, they said, it conflicts with more than a century of court precedents that allow people to sue to block state actions that are inconsistent with federal law.

The brief was filed by seven influential Democrats, including Representative Henry A. Waxman of California, an architect of Medicaid; Representative Nancy Pelosi of California, the House minority leader; Senator Harry Reid of Nevada, the Senate majority leader; and Senator Max Baucus of Montana, the chairman of the Finance Committee.

Similar arguments were made in a separate brief filed by a dozen former federal health officials, including Donna E. Shalala, the secretary of health and human services under President Bill Clinton; Joseph A. Califano Jr., who was health secretary under President Jimmy Carter; and Bruce C. Vladeck, who was in charge of Medicaid and Medicare in the Clinton administration.

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.”

Medicaid, the fastest-growing item in many state budgets, provides health insurance to more than 55 million people, including children, people with disabilities and nursing home residents.

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. When states cut reimbursement rates, they save money, and so does the federal government, which pays 50 percent to 75 percent of the costs.

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 Justice Department, siding with California, told the court in May that no federal law allowed individuals to sue states to enforce this standard. The Democratic leaders said Congress intended to allow such lawsuits.

“California has been accepting more than $20 billion in federal Medicaid funds per year in exchange for its promise, among other things, to ensure that needy patients had access to health care,” their brief said, adding, “California has failed to adhere to its obligations.”

“Impoverished Medicaid patients and the medical providers who serve them” must be allowed to challenge state violations of federal law by invoking the supremacy clause, the Congressional leaders said.

The Justice Department says federal health officials have “exclusive responsibility” for ensuring state compliance and can cut off Medicaid money for a state that does not comply.

However, the former federal officials told the Supreme Court that exclusive enforcement by the Department of Health and Human Services was “logistically, practically, legally and politically unfeasible.” The department, they said, does not have enough employees or money to enforce the guarantee of equal access to care for Medicaid patients.

In previous administrations, they said, the department “supported and embraced” lawsuits by beneficiaries as a way to help achieve Medicaid’s goals.

AARP, the American Hospital Association, the American Medical Association, civil rights groups and the U.S. Chamber of Commerce also weighed in with Supreme Court briefs supporting the beneficiaries and providers. “Judicial enforcement is the only viable means to remedy states’ noncompliance with the Medicaid Act,” the A.M.A. said.

The National Governors Association endorsed California’s position that Medicaid recipients had no right to sue.

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