November 23, 2021

OFFICIAL LAWLESSNESS: On ObamaCare, Democrats Defy the Supreme Court.

The multitrillion-dollar tax, climate and entitlement spending bill the House passed last week cuts funding for hospitals that treat uninsured patients. It likely violates the Constitution in the process by punishing states that have declined ObamaCare’s Medicaid expansion.

Seven states, including expansion and nonexpansion states, still use uncompensated-care pools to reimburse providers for charity treatment. Section 30608 of the Build Back Better bill contains two separate provisions that would apply solely to nonexpansion states. The first would reduce by 12.5% their Medicaid disproportionate-share hospital payments, which offset the costs of hospitals that treat high numbers of uninsured patients.

The Biden administration has already attempted to use the uncompensated-care pools as leverage to dragoon states like Florida, Texas, Tennessee and Kansas into Medicaid expansion. The Centers for Medicare and Medicaid Services in April revoked an extension of Texas’ 1115 waiver, a decision that a federal judge struck down in August. The language in the House bill would give CMS new grounds to reject, or at minimum scale back, the nonexpansion states’ uncompensated-care pools.

While the new subsidies authorized under the bill would expire in 2025, the reductions in Medicaid payments—which the Congressional Budget Office estimates at approximately $4 billion a year—are permanent.

That clearly violates the Supreme Court’s 2012 ruling in NFIB v. Sebelius, which declared ObamaCare’s mandatory expansion of Medicaid unconstitutionally coercive on states.

Coercion and lawlessness are right on-brand.

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