Last week the Supreme Court issued its ruling on the constitutionality of the Affordable Care Act, or as I like refer to it, “Federal RomneyCare.” While the majority of coverage and interest in the case centered around the ACA’s “individual mandate,” a somewhat lesser known issue involving Medicaid has interesting implications for federal and state education policy, particularly in California.
Before getting to that, a quick refresher on health care policy. Medicaid is a cooperative federal/state program whereby the federal government sends money to states so that the states may provide health care to certain vulnerable groups – for example, the blind, the elderly, and the disabled. The ACA as drafted required states to expand the Medicaid program to cover all individuals below the age of 65 with incomes below 133% of the federal poverty line, thus extending health-care coverage to 17 million previously uninsured Americans. If a state refused to expand Medicaid in this fashion, the ACA empowered the Secretary of Health and Human Services to withhold all of the state’s Medicaid funding.