Altering The Deal: HHS Goes To The ‘Dark Side’ With Medicaid Waiver Threats


U.S. Supreme Court Prohibited Obama Administration From Holding Medicaid Funding Hostage

As originally written, Obamacare required states to expand their Medicaid programs to include a new class of able-bodied adults who have never before qualified for long-term welfare. That requirement was enforced by a giant political stick: if states did not change their programs’ eligibility guidelines to include these new enrollees, the Secretary of Health and Human Services could deny funding for a state’s entire Medicaid system. Medicaid would no longer be focused on the truly needy it was supposed to serve; it would instead include millions of adults with no dependent children and disabilities keeping them from meaningful employment.

In National Federation of Independent Business (NFIB) v. Sebelius, the Supreme Court described Obamacare’s mandatory Medicaid expansion as an unconstitutional “gun to the head” of states. The Court struck down that requirement with a robust 7-2 majority.