National Federation of Independent Business v. Sebelius and Medicaid expansion constitutionality

NFIB vs. The Affordable Care Act

The Affordable Care Act brought to the Supreme Court by 26 states of the United States to determine its constitutionality, was confirmed by the courts as was expected by many people. The case was between National Federations of Independent Business v. Sebelius (NFIB). The Supreme Court upheld the ACA and its expansion in a fragmented and complicated opinion that saw it also limit the ability of the federal government to hold back federal Medicaid funds unless states accept and comply with the ACA Medicaid requirements for expansion. The expansion requirements include non-pregnant women below the age of 65 with income that falls below 133% of the poverty levels determined by The Federal Government (FPL) for eligibility for Medicaid benefits (Swendiman and Baumrucker 2012). This is provided for in Section 2001 of Title II of ACA, which came into effect on January 1st 2014.

In the ruling by the Supreme Court, it was found that forcing the states to comply with, or even participate in the Medicaid expansion with a treat of withholding federal funds, if such states failed to comply, was coercive and thus unconstitutional as per the United States Constitution and the Tenth Amendment; it says that Congress may make use of its spending power to give incentives to the states that comply with federal policies. However, when such pressure becomes forceful, such legislation runs contrary to the principles of federalism. The Supreme Court declared that the solution to the violation of the constitution at the moment was to restrict the enforcement of ACA Medicaid Expansion program to the aspect of withholding the matching funds from the federal government meant for newly eligible people under ACA Medicaid plan. In Actual sense three Judges, namely Justices Breyer, Kagan, and Chief Justice Roberts would have declared the Medicaid expansion program requirements as unconstitutional, but that there is a constitutional violation by virtue of the threats to the states through the proposal to withhold Medicaid funds if they do not comply with the expansion requirements. Two Justices, i.e. Sotomayor and Ginsburg declared that the expansion program was wholly constitutional. Four Justices; Justices Scalia, Kennedy, Thomas, and Alito in their dissent remarks would have struck down the expansion program (Swendiman and Baumrucker, 2012). Finally, though, the dissenting justices concurred with Chief Justice Roberts that the threat to withhold federal funding for the program was coercive and unconstitutional. This provided the required majority of 7 justices to seal the verdict on the case. Another set of five justices agreed with the chief justice in his declaration to strike out only the provision that calls for withholding Medicaid matching funds for failure to comply.

Reflect Class/Race/Gender

The Medicaid program was established in 1979. It is meant to assist all needy people including pregnant women, children the handicapped and elderly people to obtain medical care. States are required to comply with the set federal criterion that governs matters such as the particular persons eligible to the funds and the cost of their treatment. All states had decided to take part in Medicaid by 1982. The federal funds received from the federal government for the purpose of Medicaid programs have become a significant portion of the budgets that states make. Indeed, the Medicaid funds constitute 10% or slightly higher for most state budgets. The current Affordable Care Act expands the scale of the program under Medicaid and has increased the number of persons that the states need to include in their medical cover (National Federation of Independent Business V. Sebelius, Secretary of Health and Human Services).

One of the challenges in the new program is the requirement for states to extend their medical cover to adults with incomes below 133% of the poverty level provided. Several states only cover adults with children if their income is considerably low. Many of these states do not extend the cover to adults without children. The new Act has increased the funds availed to states to cover for their expanded medical program; even if the states foot part of the bill. The act points out that if states do not comply with these new requirements, they will not only lose matching funding for the expansion program but the whole Medicaid federal funding. Congress addressed the issue of people who cannot access insurance cover owing to the conditions that existed earlier or other issues related to health. The Congress addressed the matter through the "guaranteed issue' and the community rating provisos. These policies prohibit insurance firms from denying cover to those with the mentioned conditions or imposing higher premiums on unhealthy people. The "community rating' and "guaranteed issue " provisos do not address healthy individuals who do not purchase insurance for covering potential needs of health care needs (National Federation of Independent Business V. Sebelius, Secretary of Health and Human Services).

In actual sense, the reforms seem to aggravate the problem by giving incentives to persons to delay in purchasing health insurance cover until the point they fall ill, even as they rely on the promise by the federal administration to provide guaranteed and affordable coverage.

The reforms may also impose large insurance costs in insurance firms because they are required to accept people with health issues at hand; yet restricted from charging them extra premiums required to cover their health insurance. The scenario may lead to the insurance firms increasing cover cost for everyone.

Relevance to the Nuns

Nuns normally do not have children. Medically speaking, women who do not have children experience a higher number of menstrual cycles compared to the ones with children. The occurrence of more cycles portends a higher risk of cancer. The authors of the study that came up with these findings stated that almost 95-000 nuns worldwide pay a heavy price for chastity. These women face a greater risk of developing cancer of the ovary, breast and uterus (Jaslow, 2011). If the catholic fraternity availed the oral conceptive pill available for free to all nuns it would bring down the risk of such occurrences and provide the plight of the nuns and due attention and recognition. Professor Roger Short of the University of Melbourne and Dr. Kara Britt of Monash University pointed the latter fact in their written statement. The Catholics condemned all manner of contraception in 1968 led by Pope Paul VI's Humanae Vitae in 1968. However, the authors of the study point out that the nuns should be exempt. The document states that the Church should not in any way regard therapeutic practice aimed at healing people as unlawful even if they may have a contraceptive effect. So the question arises as to where the authors got the idea that the Catholics control the medical care of the nuns? - Maryanne Walsh of the U.S. conference of Catholic Bishops. She pointed out to ABC news that nuns have equal access to medical care as everybody else; and that includes the pill (Jaslow, 2011). Such activism can be related to the days of the agitation for women's rights under the leadership by Elizabeth Cady Stanton. The "Declaration of Sentiments and Resolutions" referred to as Seneca Falls, was meant to deal with state laws that oppressed women (Elizabeth Cady Stanton). It is seen in retrospect, now, that contraception ought to have been one of the laws. The new law for health makes it easy to access preventative care to millions of American people. This is particularly important to women who are more likely to avoid necessary health care such as preventative health care as a result of the cost implications. In order to deal with the cost issues and enable all women to access preventative health care, a section of the new health care law demands that all new private insurance schemes should cover a provided range of preventive health care service. Such service includes pap smears, mammograms, prevention of smoking and use of contraceptives with no co-payments or related cost sharing demands (Contraceptive Coverage in the New Health Care Law: Frequently Asked Questions). The list of prescription contraceptives approved by FDA is included in the requirements. It implies that women can access oral contraception pill and the jab (Depo-Provera), the ring diaphragm, cervical caps, contraceptive implants and permanent contraceptive interventions without having to pay for them. Consequently, nuns would be absolved of paying taxes thereto.

"References"

"Contraceptive Coverage in the New Health Care Law: Frequently Asked Questions." National Women's Law Center. 2011. Web. 4 May 2016.

Elizabeth Cady Stanton

Jaslow, Ryan. "Should Nuns Take Birth Control Pills? What Study Says." CBS News. N.p., 2011. Web. 4 May 2016. .

"NATIONAL FEDERATION OF INDEPENDENT Business v. SEBELIUS, SECRETARY OF HEALTH AND HUMAN SERVICES." Cornell University Law School. N.p., 2012. Web. 3 May 2016. .

Swendiman, and Baumrucker. "Selected Issues Related to the Effect of NFIB v. Sebelius on the Medicaid Expansion Requirements in Section 2001 of the Affordable Care Act." N.p., 2012. Web. 3 May 2016. .

"The Patient Protection and Affordable Care Act: An Overview of Its Potential Impact on State Health Programs." Legislative Analyst's Office. N.p., 2010. Web. 4 May 2016.