Tag Archives: Medicaid

Covid and the Supreme Court

While many of us were enjoying time off for end-of-year holidays, the United States Supreme Court added extra work for several lawyers.   On December 22, the Supreme Court issued two orders in four cases involving two of the Biden Administration’s vaccine mandates — one involving health care workers and one involving large employers.  In these orders, the Supreme Court granted review and set the cases for expedited argument this upcoming Friday (January 7).   There are several issues worthy of comment on this order.  The first comment is a little “inside baseball.”  The other has to do with what is really happening here as oppose to how the media might comment on this case.

Starting with the inside baseball part of this issue, over the past several years, there has been growing criticism of how the Supreme Court is using the “shadow” docket.  The shadow docket is a reference to applications for stays of lower court rulings (or alternatively a request that the Supreme Court issue a temporary injunction that the lower court refused to issue).   If the application is completely frivolous, it can be denied quickly by an order.  If there is some merit, the Supreme Court might request a response.  After receiving the response, the Supreme Court typically resolves the application by an order or a brief unsigned “per curiam” opinion.  Unless some justice opts to file a concurring or dissenting opinion, the order or opinion does not note the votes of the justices.  All that we know is that, at least five justices, agreed with the order or opinion.  These cases are typically resolved without full briefing or argument.  As some significant issues have come through the shadow docket over the past several years, this process has come under some criticism.  This year, we have seen the Supreme Court opt to grant argument on three separate occasions to matters arising from the shadow docket — first on a question about ministers in the execution chamber (argued but still awaiting a decision), second on the ability to challenge the Texas abortion statute, and now on the Biden vaccine mandates.  In the first two cases, the parties did get to submit full briefs on an expedited basis.  That is not so for the vaccine mandates.  While, maybe, the Supreme Court would have gone this right under any circumstances, clearly the fact that the shadow docket is starting to become an issue is something that the Supreme Court has to be concerning to the justices.  Perhaps, the Supreme Court will continue to hold expedited argument on major issues arising on the shadow docket to avoid Congress taking action.  Only time will tell.

Turning to the merits, while the media will focus on these cases being about vaccine mandates, that framing is misleading at best and wrong in many respects.  While the cases do involve a challenge to vaccine mandates, the legal issues have very little to do with vaccine mandates.  There is no claim in these cases that vaccine mandates violate the rights of anybody.   Cases asserting a right to not be vaccinated have uniformly been rejected.  (To be blunt, those cases demonstrate the hypocrisy of the right wing of the Republican Party.  At the same time that they are asking the court to overturn Roe vs. Wade, they are bringing these cases asserting a right to bodily autonomy that depend largely on Roe.)  Instead, these cases involve two other issues. Continue Reading...

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Health Care 2019

Barring something unexpected, as discussed in Doc Jess’s post, the major action for the rest of this Congress on health care is likely to be at the administrative level with Tom Price doing his best to undermine the Affordable Care Act.  However, there have been some unanticipated holes that have developed over the past seven years that do need to be fixed.  As such, if Democrats regain control of the House and Senate in 2019 what issues should they be looking to address.

At the top of my list is the Medicaid expansion hole.  Back in 2012, the Supreme Court ruled that states did not have to participate in the Medicaid expansion.  The Affordable Care Act assumed that every state was going to participate in the expansion and only provided for subsidies for those who did not qualify for Medicaid.   When a significant number of states opted to not expand Medicaid coverage, this created a group who earned to much to sign up for Medicaid, but too little to get subsidies to purchase insurance.  The obvious fix is to expand the subsidies to cover this gap group.

The second issue concerns the exchanges.  Again, the Affordable Care Act assumed that most (if not all) states would opt to set up exchanges just on principles of state autonomy.  (Why would Republicans who complain about the feds taking over the insurance market let the feds take over the insurance market in their states?)  It turned out that Republicans in the state wanted the symbolism of resisting more than actual local control.  This problem offers a chance to offer the Republicans a two-edged sword.  The Republicans complain that one of the problems with health insurance is that companies are unable to offer policies that cross state lines.  (Placing the blame on regulations is not accurate, and the biggest restraint on such policies is the need of insurance companies to have deals with the local hospitals.)  So I would offer up for discussion an exemption for policies offered on the federal exchange.  If a state does not have its own exchange, policies on the federal exchange will be exempt from state regulations and will only be subject to federal regulations.   If a state wants to regulate those policies, it can take over the exchange.  If not, a state will not be permitted to sues state regulations to obstruct the federal exchange.  My hunch says that the states will not opt to set up their own exchanges and that the exemption of insurance companies from state regulations will not increase the number of policies that cross state lines. Continue Reading...

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