The Supreme Court just denied an ACA appeal. That’s a relief.

The Supreme Court today declined to hear Maine’s appeal in a case involving a constitutional challenge to an ACA provision relating to Medicaid. That’s good news for supporters of the law, who had no desire to relive the fight over constitutional coercion in yet another case about the ACA.

What’s the case about? The ACA says that, as of the date of its enactment, the states can’t restrict the category of kids and young adults who are eligible to receive Medicaid. Known as a “maintenance of effort” provision, the ACA freezes Maine’s eligibility rules for that population.

Before the ACA, Maine chose to cover 18- to 20-year-olds in its Medicaid program. After the ACA, the state wanted to restrict its eligibility rules—but the maintenance-of-effort provision said it couldn’t. So Maine sued, arguing that the ACA placed an unconstitutionally coercive condition on the receipt of its Medicaid dollars.

The First Circuit—quite properly in my view—rejected the argument. Under the Chief Justice’s controlling opinion in NFIB v. Sebelius, a federal spending condition is unconstitutional where failure to adhere to the condition not only threatens the loss of federal funds tied to a given program, but also the loss of federal funds tied to a substantial and independent program.

In NFIB, the Chief concluded that the Medicaid expansion was a new program—call it Obamacaid. Because a state had to adhere to the rules of Obamacaid or lose all of its existing Medicaid money, the Chief reasoned, the expansion was unconstitutionally coercive.

Here, however, the maintenance-of-effort provision applied only to Maine’s traditional Medicaid program. By the Chief’s lights, adjusting the rules for an existing program isn’t unconstitutionally coercive since it doesn’t threaten the loss of independent federal funding. If Maine didn’t wish to comply, it would lose all of its Medicaid dollars—but it wouldn’t also lose, say, its education funding.

The Supreme Court’s rejection of Maine’s petition suggests that the Chief is not inclined to revisit his coercion decision in NFIB. If he was convinced that the First Circuit botched it, he probably could have persuaded his conservative colleagues, who have a more expansive view of what counts as unconstitutional coercion, to hear the case.

More subtly, the Court’s refusal to hear the case suggests that the Court won’t use King v. Burwell to shift the law on what counts as unconstitutional coercion. Were such an opinion in the works, the Court would have held onto Maine’s petition and, after issuing King, given the First Circuit a chance to reconsider its decision.

Does that portend anything about the outcome in King? I don’t think so. The justices who think that adopting the plaintiffs’ interpretation raises coercion concerns—Justice Kennedy, perhaps, or even the Chief Justice— could rule for the plaintiffs on statutory grounds, while flagging the constitutional concerns for future litigation. Alternatively, they could rule for the government in an effort to avoid potential constitutional concerns.

Either way, the Court’s decision wouldn’t call into question the outcome of the First Circuit case. Beyond signaling that the Court won’t use King to rewrite the coercion doctrine—an unlikely outcome in any event—the denial of Maine’s petition doesn’t tell us much about King. We’re still in a waiting game.


Hidden information below


Email Address*