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States get chance to make their case on Medicaid

Associated Press

WASHINGTON (AP) – States are complaining that the U.S. government made them a health care offer they can’t refuse _ but they’d sure like to.

And on a doubly busy Wednesday ending three days of hearings, the Supreme Court has another issue to consider: If justices throw out a key piece of the health care law, should they keep the rest of it?

First up, the question of what to do if the court rules unconstitutional the requirement that people have insurance or pay a fine.

The main arguments:

_ Challengers say throw the whole law out. They argue that the hundreds of provisions all relate to its central mission _ providing affordable health insurance to all without overburdening taxpayers. Without the mandate to spread the risk and raise additional financing from premiums, they say, that mission collapses.

_ The Obama administration says much of the law should be left standing. But it says some parts do depend on the insurance mandate and would have to be tossed out: rules that insurers can’t turn away the old or sick or charge them too much.

_ The justices appointed a Washington lawyer to argue a third position, that the rest of the law should survive unchanged. Congress wouldn’t want the sick to pay more or be denied coverage, this argument goes, even without the insurance mandate.

Next, the court hears from 26 states saying Congress is coercing them into accepting the law’s major expansion of the Medicaid program for the poor.

The main arguments:

_ The states say their only way out is to leave the Medicaid program completely and lose all the federal money it brings, something they can’t afford to do. But they say they can’t bear the cost of expanding their Medicaid rolls, either. They argue the health care law goes beyond any existing state-federal programs because of its size and the sweep of its rules.

_ The Obama administration says the U.S. has the power to decide what strings go with money it sends to states. Changing that would endanger other state-federal programs, it argues. And the government says it, not the states, will bear all but a small slice of the added cost.

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